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Lower Extremity Amputation and Prosthetics

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Declined due to improved surgical techniques and assessment of vascular function. ... advised due to poor blood supply in distal leg. Transtibial Amputation ... – PowerPoint PPT presentation

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Title: Lower Extremity Amputation and Prosthetics


1
Lower Extremity Amputation and Prosthetics
  • Understanding, Evaluation and Challenges

2
Prosthetics Vs. Orthotics
  • Prosthesis An artificial device used to replace
    a missing body part, such as a limb, eye, or
    heart valve.
  • Orthosis An application or apparatus used to
    support, align, prevent, or correct deformities
    or to improve existing function of movable parts
    of the body.

3
Amputation rates increase with
  • chronic disease, i.e. complications of diabetes,
    and peripheral vascular diseases,
  • being male, traumatic amputations i.e. automobile
    accidents, freezing, burns, farm machinery and
    power tool accidents,
  • increasing age
  • being a member of a racial or ethnic minority

4
Rates of Causes for Amputation
  • 70 of amputations are performed for vascular
    disease including diabetic complications,
    arteriosclerosis and thromboembolism,
  • 22 due to traumatic injuries and infection
  • 4 result from malignancies
  • 4 due to congenital deformities

5
Lower Extremity Amputation Levels
  • Hemipelvectomy and Hip Disarticulation
    amputation of the entire leg including lateral
    portion of pelvis being the ilium, ischum, or
    pubis of same side. Usually done in cases of
    malignant tumors, extensive gangrene, infection
    and trauma
  • Disarticulation a separation at the joints, hip
    or knee
  • Rotationplasty NEJM -- Rotationplasty for
    Ewing's Sarcoma of the Distal Femur -- Data
    Supplement -

6
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8
Rotationplasty
9
Transfemoral Amputation Levels
  • Short large weight-bearing surface if done at
    level of lesser trochanter, retains femoral head,
    and greater trochanter resulting in an improved
    prosthetic fit. Declined due to improved surgical
    techniques and assessment of vascular function.

10
Transfemoral Amputation Levels
  • Medium At least 410 cm above lower end of femur
    to allow room for prosthetic knee.
  • Knee disarticulation Retains thigh muscles
    giving good muscular balance, growth potential is
    maintained, provides good weight bearing, results
    in difficulty of swing phase control in walking,
    cosmetic asymmetry due to a prosthetic knee that
    extends below the other.

11
Transtibial Amputation Levels
  • Very Short Usually results from trauma, not an
    elective procedure, very small moment arm,
    retains knee.
  • Standard Elective amputation, provides a well
    padded and effective biomechanical lever arm, at
    lease 8 cm of tibia is required.
  • Long Not advised due to poor blood supply in
    distal leg.

12
Transtibial Amputation Levels
  • Syme Named for James Syme, a scottish physician
    mid 1800s, Ankle disarticulation, residual limb
    with good function due to long lever arm to
    control prosthesis, ideally suited for weigh
    bearing and can last life of patient, can walk
    without prosthesis, disadvantages of chronic
    nerve damage to posterior tibial nerve.

13
Transmetatarsal Amputation
  • Approximately 10,000 performed in US with a 30
    failure rate, attributed to the combination of
    substantial loss of weight bearing area and
    reduced length of lever arm to generate a
    plantarflexor movement. Limited to patients with
    good anterior tibial pulse and blood flow,
    usually performed due to trauma, infection,
    frostbite, diabetes, arteriosclerosis localized
    to the phalanges.

14
Patient Challenges
  • Psychosocial Body image, self-esteem, struggle
    with change in appearance
  • Adults Livelihood, functional capacity,
  • interpersonal relationships
  • Young Identity, sexuality and social
    acceptance
  • Most difficult transition are those individuals
    that are young adults, not married, history of
    addiction

15
Patient Challenges
  • Financial Concerns Cost of prosthetics Depends
    on degree of disability
  • activity of wearer, more than one prosthetic
    needed
  • types of components and materials used, metals,
    hydraulic or pneumatic pistons timed for cadence,
    microprocessors adjust pistons for a broad range
    of cadence, composite material, surgical
    silicone, sleeves
  • All customized and fitted for the individual
    to provide best fit
  • Surfaces that activities are performed effect
    dynamics of prosthetic

16
Patient Challenges
  • Phantom Limb Pain and Sensation
  • Pain perception of pain in the absent
    extremity
  • Sensation perception of the absent
    limb
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