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Prosthetics & Orthotics – Questions And Answers
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Prosthetics & Orthotics – Questions And AnswersEtiology of amputations Correct Ans - *#1: vascular disease* (DM &
PAOD) severely increases mortality risk post-amputation
(PAOD and not DM is possible; DM usually involves PAOD)
-Infections
-Trauma
-Cancer (better today than it used to be; they now remove the whole bone)
-Congenital
STATS: 1.5 amputations per 1000 ppl —> prevalent!
Toe Amputation Correct Ans - amputate distal to MT heads
no prosthetic
ORTHOTIC?: shoe w/filler for that dead space; prevents drifting of
foot/malalignment
Transmetatarsal ("partial foot" amputation) Correct Ans - prox. to MT
heads, through shafts
suture line doesn't heal very well w/vascular involvement
ORTHOTIC:
-shoe w/filler for that dead space; prevents drifting of foot/malalignment
-shoe w/rocker bottom: b/c they've lost MTP jts, for good heel-toe gait
-shoes w/lift to allow heel-to-ground contact
ROM: maintain DF ROM! Pts often have PF contracture
Surgical options for TMT Amputation Correct Ans - -myodesis (where
they suture the muscle/tendon to the remaining limb/bone)
-myoplasty (suture to other soft tissue)
or the surgeon lets the muscles retract
Bone shaving / bv ligation / nerve retraction Correct Ans -
Lisfranc Amputation Correct Ans - Disarticulation of mid-foot between
tarsal and metatarsal bones
ORTHOTIC: shoe w/rocker, filler & cushy heel for shock-absorption (still no
prosthetics)
ISSUE: Disruption of fibularis brevis onto the base of the 5th metatarsal leads
to varus deformity
,Chopart Amputation Correct Ans - C - calcaneus, T - talus
Disarticulation of talonavicular and
calcaneocuboid joints.
ORTHOTIC: shoe w/rocker, filler & cushy heel for shock-absorption (still no
prosthetics)
ISSUE: Commonly complicated by equinovarus foot deformity
- Results from unopposed tendon action
- Fix is Achilles' tendon lengthening
Syme Amputation Correct Ans - done through the ankle joint. The foot
is removed but the heel pad is saved so patient can bear weight.
PROSTHETIC: 1st prosthetic: SACH foot is most common (solid ankle cushy
heel)
cushy heel creates the PF of the foot
flexible material in forefoot allowing roll-over
Boyd Amputation Correct Ans - amputation at the level of the ankle
with preservation of the calcaneus and heel pad and consequent fixation of
the calcaneus to the tibia.
Allows for complete weight bearing and provides both stabilization of the heel
pad and suspension for a prosthesis.
Transtibial Amputation (surgery) Correct Ans - Below knee
amputation (BKA)
SURGERY:
-Never amp. into lower ¼ of leg (not enough soft tissue to protect stump —>
lots of skin issues)
-Residual gastroc heads, wrapped around, sutured anteriorly
Initial PT for Transtibial Amputation Correct Ans - maintain mobility
at and around suture line (mobilize ON suture line once it's healed)
ROM to prevent knee flexion contracture: pain will lead pt to stay in flexion,
promote extension!
Knee Disarticulation Correct Ans - amputation done between bone
surfaces, rather than by cutting through bone.
POPULATION: Children and traumatic amputees
,PLUS: Thigh muscles tend to be stronger because they are released at their
distal (far) end, rather than transected at mid-muscle.
MINUS:
-Hard to get good prosthetic fitting
-Poor alignment btn prosthetic and
Transfemoral Amputation Correct Ans - Above knee amputation
(AKA)
SURGERY: want it to be as long as possible (don't need to stay away from
lower ¼ like BK's); don't want to go any higher than lesser trochanter
KINEMATICS:
[W/C for levels 8 and up can be good (d/t high energy expenditure, QOL can
be improved)]
Transfemoral Amputation (AKA) Kinematics Correct Ans - hip ext to
create knee ext
hip flex to create knee flex
LONGER LEVER important in controlling prosthetic knee
and less disruptive to your COG (the more mass that's lost, the more COG
disruption)
more surface area = better balance, better for avoiding pressure sores
Transfemoral Amputation (AKA) Early Issues Correct Ans - ROM: hip-
flexion contractures common —> have them lay on their stomach!
[lots have vascular issues, they're often in chair to help]
ROM: hip-abduction contractures —> esp. short stumps, b/c ADD tubercle
attachments (near greater trochanters) are lost
work on add. isometrics
Transfemoral Amputation (AKA) Prosthetics Correct Ans - geriatric
locked knee if pt is weak, vs. free knee units
"C-legs" (computer legs) are amazing, but very expensive
, Hip Disarticulation Correct Ans - SURGERY: Femoral head comes out,
everything distal is gone
glute tissue, wrap anteriorly
PROSTHESIS:
prosthesis has shelf for WB on stump and ischial tuberosity
KINEMATICS: post. pelvic tilt for leg swing
can be functional, but high energy expenditures
Hemipelvectomy Correct Ans - Complete hemipelvectomy is removal
of half pelvis.
POPULATION: Cancer in pelvis
Hemicorporectomy Correct Ans - body below the waist is amputated,
transecting the lumbar spine.
-Removes the legs, the genitalia (internal and external), urinary system, pelvic
bones, anus, and rectum
PROSTHESIS: Like a bucket, you can then set pt into W/C
Pre-Op PT Correct Ans - can work on transfers, hopping w/walker
bed positioning
Residual Limb Length (short vs. long) Correct Ans - short = <40%
long = >60%
Surgical Flap: AK vs. BK Correct Ans - AK: suture line at inferior
surface
BK: suture line on ant. surface
Post-op wound dressing Correct Ans - optimal wound env.
-if lots of drainage: foam
-if not lots of drainage: occlusive dressing
mild compression almost immediately: edema, shaping, venous return, good
for pain
SOFT: ACE wrap, shrinker
HARD: not for vascular, but traumatic pt: IPOP (immediate post-op
prosthesis), allows pt some standing/amb, but not full WBing
-pole attached to stump w/prosthetic foot
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