Prosthetics & Orthotics: Exam I Questions & Answers(RATED A)

Prosthetics & Orthotics: Exam I Questions & Answers(RATED A) Etiology of Amputations - ANSWER1. Vascular Disease (Diabetes & PAOD most common) 2. Infections 3. Trauma 4. Cancer 5. Congenital Toe Amputation - ANSWER*Distal to MTP joint*. ORTHOTIC: - NONE - Shoe filler for dead space Transmetatarsal Amputation - ANSWERAka "partial foot" amputation; *proximal to MT heads & through MT shafts. ORTHOTIC: - NONE - Shoe filler for dead space - Rocker bottom shoe - Lift in shoes to allow heel-to-ground contact ROM: - Maintain DF ROM & prevent PF contracture ISSUES: - Healing of suture lines Myodesis vs. Myoplasty - ANSWER*Myodesis* - surgical attachment of tendon/muscle to bone. *Myoplasty* - surgical attachment of tendon/muscle to other soft tissue. Lisfranc Amputation - ANSWERDisarticulation of mid foot with *removal of metatarsals with preservation of tarsals*. ORTHOTIC: - NONE - Shoe filler for dead space - Rocker-bottom shoe - Cushioned heal (promotes plantarflexion) ISSUE: - Disruption of fibularis brevis onto the base of the 5th metatarsal leads to varus deformity Chopart Amputation - ANSWERDisarticulation of talonavicular and calcaneocuboid joints with *preservation of talus & calcaneus*. ORTHOTIC: - NONE - Shoe filler for dead space - Rocker-bottom shoe - Cushioned heal (promotes plantarflexion) ISSUES: - *Equinovarus foot deformity* resulting from unopposed tendon action Syme Amputation - ANSWERDisarticulation of ankle joint with *removal of talus & calcaneus* from mortice (heel-pad is preserved). PROSTHETIC: (1st level requiring prosthetic) 1. *SACH Foot* - solid ankle cushy heel that creates eccentric PF movement of the foot 2. *PTB Shelf* - patella tendon bearing adds weight to residual limb Boyd Amputation - ANSWERamputation 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) - ANSWER*Below Knee Amputation (BKA)*. SURGERY: - Uses a *posterior flap* involving wrapping the residual heads of the gastrocnemius around & nurturing anteriorly - Amputation stays *above distal 1/4* of the residual limb due to skin irritations that occur in the think skin of the distal 1/4 and below Initial PT for Transtibial Amputation - ANSWERmaintain 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 (population, pros, cons) - ANSWERAmputation done between bone surfaces, rather than by cutting through bone. POPULATION: 1. Children (to avoid cutting through growth plates) 2. Traumatic amputees 3. BKA with knee flexion contracture or non-functional knee PROS: - Thigh muscles tend to be stronger because they are cut at their distal tendons rather than muscle bellies CONS: - Hard to get good prosthetic fitting due to *bulbous end* - Asymmetrical prosthetic knee unit is lower than the anatomical knee (poor alignment) Transfemoral Amputation - ANSWER*Above Knee Amputation (AKA)*. SURGERY: - The longer the residual limb, the better (no shorter than the greater trochanter) for ADductor attachments - However, longer residual limbs are NOT as good for myodesis (less padding due to intact muscle belly) & prosthetic fitting - Uses *long anterior flap* with suture are the bottom of the residual limb What type of contractures are common in AKAs? - ANSWERHip flexion & ABduction contractures. Transfemoral Amputation (AKA) Kinematics - ANSWERhip 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 - ANSWERROM: 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 - ANSWERgeriatric locked knee if pt is weak, vs. free knee units "C-legs" (computer legs) are amazing, but very expensive Hip Disarticulation - ANSWERSURGERY: - Femoral he