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7/29/2019 Amputaion in Orthos
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Amputations and Prosthetics
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Amputations are classified at the level
where the amputation takes place
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Types and levels
congenital
Acquired
lower extremity upper extremity
Forequarter
Intrascapulothorasic
shoulder disarticulation
Transhumeral
above elbow
Elbow Disarticulation
Transradial
below elbow
wrist disarticulation
Transcarpal
Metacarpal phalangeal Transphalangeal
partial hand
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The higher the amputation, the more difficult it is
to use a prosthesis & the less mobility the
extremity will have
Amputations just above or below a joint are
problematic
When a surgeon performs the procedure, as muchlength as is possible is salvaged
Muscle tissue is reattached as best as possible but
line of muscle pull may be disrupted
Skin closure is a problem too. Needs a thick skin
pad to protect residual limb.
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Diabetes
Frequently results in amputations
decreased blood flow to extremity
decreased sensation to extremity
wound develops which person does not feel
wound becomes infected and cannot heal
amputation is done as distal as is viable
surgeon amputates until viable blood flow is reached
frequently extremity will be further amputated as
disease progresses
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Diabetes Cont.
It is important that we teach pt to self
inspect their extremities
Proper diet is important
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Problems associated with
congenital amputations
Child has never learned to function with
that extremity
Early prosthesis of some type is needed so
child will use the arm
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Phantom limb sensation/pain
The sensation that the amputated extremity
is still there
Pain treated with TENS, desensitization,
fluidotherapy, US, nerve blocks or surgery
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Other complications S/P amputation
Depression is common
Falls
stand on side of LE amputation
balance is greatly disturbed
body center of gravity is changed
balance must be relearned
protective reactions must be changed
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Stump Management
Shape residual limb so it is tapered at the distal
end to allow for prosthetic fit
Figure 8 ace bandage wrap
wrapped distal to proximal
more pressure distally
never wrap circular direction because of tourniquet
effect
pt wears wrap continually
check skin 3-4 times each day
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(stump mgmt. cont.)
Elastic shrinker or sock
less effective than ace bandage
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Removable rigid dressingplaster or fiberglass
replace as residual limb
shrinks
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E l P/O h i
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Early P/O prosthesis
fitted within first 30 days
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Desensitization
percussion
weight bearing
massage
tapping and rubbingresidual limb
limb wrapping with acebandage
fluidotherapy
rice, beans, etc.
vibrator Maintain ROM &
strength
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Develop independence with ADLs