Exam (elaborations)
Prosthetics & Orthotics Questions and Answers 2024
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Prosthetics & Orthotics
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Prosthetics & OrthoticsEtiology of amputations - answer*#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 - answeramputate distal to MT heads
no prosthetic
ORTHOTIC?: shoe w/filler for that dead space; prevents drifting of foot/malalignment
Transmetatarsal ("partial foot" amputation) - answerprox. 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 - answer-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 - answer
Lisfranc Amputation - answerDisarticulation 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 - answerC - 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 - answerdone 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 - 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) - answerBelow 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 - 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 - answeramputation 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 - answerAbove 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 - 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 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 - answerComplete hemipelvectomy is removal of half pelvis.
POPULATION: Cancer in pelvis
Hemicorporectomy - answerbody 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 - answercan work on transfers, hopping w/walker
bed positioning
Residual Limb Length (short vs. long) - answershort = <40%
long = >60%
Surgical Flap: AK vs. BK - answerAK: suture line at inferior surface
BK: suture line on ant. surface
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