Limb Loss & Prosthetics

Overview

100

You are talking to your DM patient with retinal and peripheral neuropathy about the importance of skin and shoe checks as more than 80% of lower-limb amputations are preceded by this condition

Foot ulcer

200

The greatest percentage of amputations are caused by this etiology followed by cancer and congenital conditions

Dysvascular conditions

(vascular dz; DM combined with AI)

300

The 5 major complications and challenges after amputation surgery

Phantom pain; Infection; Neuroma; Contracture; Hematoma

(Remember: PINCH)

400

Mortality from amputation d/t DM and peripheral arterial disease is significantly increased by these three other conditions

(hint: related to CV system)

CAD, CVA, renal dysfunction

500

Your patient with bone cancer is worried about their upcoming amputation surgery due to "aesthetics" and that they would rather them not do this type of limb salvage procedure. You explain that this technique will actually allow them to be more functional in the long run as they will still have knee-like function.

Rotation plasty

(Typically done in those with cancer, trauma, or congenital-related complications)

Fitting

100

2 part answer: These (4) pre-requisites must be met for the preparatory prosthesis X weeks s/p surgery

Suture removed, Incision healed, Distal measure < proximal, Edema controlled

6-12 weeks s/p

200

Your next patient underwent LLE TTA d/t DM vascular complications over seven weeks ago. You explain to him that for the next X months he must gradually increase prosthetic wearing time

2-4months

300

2 part: It's been X months and your next patient is getting ready to see the prosthetist for their definitive socket. They still require their WC for grocery shopping, can walk fine on their flat driveway and inside their ranch home, but complains that they have much trouble with the cross walks because "the time is too short to cross". They will most likely be assigned this K level.

6-12 months

K1 (limited community ambulator

400

What is the limit for socks before revisiting a prosthetist

10-12 (but 15)

500

Your friend has returned from their trip in the remote Amazon. While ziplining, she got infected with flesh eating bacteria. She underwent a RLE knee disarticulation. 13 weeks later she is showing you around her hilly garden at her new townhouse. She also shares she is getting ready to attend a crowded concert this weekend. She will most likely be assigned this K level

K3 with K4 capabilities

Training

100

Poor indicators of prosthetic use include

Higher level amputation, Advanced age, Comorbidities, Cognitive impairments

200

Pre-prosthetic TherEx, donning/doffing, residual limb care, creating a wear schedule, and increasing WB and device acceptance are all part of this stage.

Early prosthetic training

300

You are working with your 52 y/o M pt with R hip disarticulation and this is his first session with his prosthetic. What is the proper wearing schedule

5-10 minutes at a time with freq skin checks and edu

400

You are starting a comprehensive gait training program for your 68 y/o M L chopart amputation patient. Your training should include these four activies

Static WB (parallel bars)

Dynamic WB (forward, backward, lateral, diag shift)

stepping activities (sound side step forward, up, lateral)

Step-stance activities (WB on and off pros side)

Community reintegration

Floor transfers and safe falling

500

Your 28 y/o L TFA patient has redness on their ASIS, greater trochanter, and ischial tuberosity. Is this concerning? Where and why?

Yes. ASIS and greater troch because they are not WB areas and are v sensitive to pressure. High risk for skin breakdown. 

Redness at the isch tub should subside once the prosthesis is removed.

Deviations

100

When the prosthetic foot/ankle is too dorsiflexed or posterior to the socket, this creates...

knee instability (1' deviation) OR knee hyperE (2' deviation

200

Causes of an anterior trunk lean

TT socket is too posterior or has no ant tilt

TT foot is too anterior

TF knee too anterior

Weak quads

Hip F contracture

Fear of buckling

300

You are watching your patient walking on their TTF prosthesis and notice early early heel rise. What kind of gait is this and what could the cause be?

2' compensatory d/t foot too PF

could be avoid knee hyperE (1' deviation)

400

Causes of vaulting

Prosthetic too long

Poor suspension

Doubt clearance

Weak hip F

500

Causes of medial heel whip

ER prosthetic knee

Varus prosthetic knee

Loose socket

Poor toe alignment

Poorly donned socket

Complications

100

You have a 57 y/o F DM patient with TTA. The pt's daughter tells you they've been working with her mom's prosthetic wearing schedule but noticed the redness at the knee cap hadn't gone away after 12 minutes. This signifies

That tissue damage has occurred (non-blanchable redness)

reactive vasodilation/hyperemia is resolution within 10 mins or less

200

Your 63 y/o TTA patient has been using her SW for the past 3 weeks after you've started gait training. She is very afraid of falling and hurting herself. You know that her using a RW is only enforcing this gait pattern

step-to gait pattern (breaks up gait cycle)

300

This type of amputee cannot easily complete step over step ascent or descent with stairs

TFA

400

Placement of the prosthetic foot too much this way creates a varus stress at the knee

Inset

500

A pt with an amputation has increased energy consumption demands and will do this to compensate

lower the SSGS (self selected gait speed)