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4 types of LE amps that don't require a prosthesis
- big toe
- trans-metatarsal
- Lis Franc (removing all metatarsals)
- Chopart (removing all but talus and calcaneus)
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Lis-Franc amputation - what is kept? What is removed?
- Kept: Tarsals
- Removed: Metatarsals
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Chopart amputation - what is kept? What is removed?
- Keep: talus & calcaneus
- Remove: tarsals & metatarsals
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Boyd's amputation - what is kept? What is removed?
- Keep: calcaneus
- Remove: talus
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 Name amputation; What is kept & what is removed?
- Lis Franc amp
- Kept: Tarsals
- Removed: Metatarsals
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What do pts w/big toe, trans-metatarsal, Lis-Franc, & Chopart amputations need? - 2
- Rocker bottom shoe +
- Soft cushion heel to promote PF w/Lis-Franc
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Common contracture for trans-metatarsal, Lis-Franc, & Chopart amputations
PF contracture (so work on DF)
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Name amputation; What is kept?
- Chopart
- Keep talus & calcaneus
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Name amputation; What is kept?
- Boyd's amp
- Keep calcaneus
- Remove talus
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Syme's amputation - what is kept & what is removed?
- Amputation through distal ankle
- Removed - tarsals, talus, calcaneus
- Preserved - Heel pad (attached to distal end of tibia for WB)
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Where should mechanical joints be for a prosthetic for a hip disartic or hemipelvectomy - hip, knee, ankle, and why?
- Hip - anterior to facil extension
- Knee -post to facil ext
- Ankle - post to facil DF
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What do you put in heel for a hip disartic or hemipelvectomy
Soft cushion heel to promote PF
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External aids in a prosthetic for a hip disartic or hemipelvectomy - where are they?
- Hip - post - prevents excessive flexion - ex - step length control strap, prevents more than 15 degrees hip flexion
- Knee - ant
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Hemicorporectomy aka translumbar amputation where is it usually?
- Amp of both limbs & pelvis btwn L4 and L5
- Pt uses a "bucket prosthesis"
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Partial hand amputation, means what?
- @ CMC joint
- keep carpals, lose everything distal
- it's like a Lis Franc, which keeps the tarsals and removes everything distal
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Wrist disartic - what's amputated
- Keep: ulna and radius
- Lose: carpals and everything distal
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Below elbow amp means what?
Removal of ulna and radius - try to keep as much as possible (at least 4 in) for muscle attachment
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Elbow disartic means what?
Lose: radius and ulna completely
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Shoulder disartic is what?
- Humerus taken out of glenoid fossa
- Remove: clavicle & scapula
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Where's the suture line & flap in a BKA?
Anterior skin flap is folded over posteriorly - suture line posterior
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Ace wrapping - AKA vs BKA - width of wrap & how
- AKA - 6" wide; start by anchoring wrap over sup iliac crest, circle torso 2x, then go down to stump
- BKA - 4" wide; 20 ft long; go from condyles down, using figure 8s
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Transtibial amputation lengths - 3
- Long - 50% of tibial
- Standard - 20-50%
- Short - 20% of the tibia
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If sitting in a WC what should BKA pts have?
A board to elevate calf & put knee into extension
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Amb goal for B/L transtibial amputees
1/3 mile (in stairs & w/aids; older or more stable amputation becomes "good" leg)
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AKA - where is suture line?
Posterior flap (skin/quad heads) and wrap it anteriorly - suture line anterior
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AKAs are most susceptible to which contracture? why?
- ABD
- Attachment sites for ADD are gone
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Transfemoral amputation femoral length - 3
- Long - 60% of femoral length
- Ideal - 35%-60% of femoral length
- Short - 35% of femoral length
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Amb goal for TF/TF amputees
100-200 ft
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What is it? What does it do? (3) Allows for what motions? (2) Used by who? (2) Not used when?
- SACH - Solid ankle cushioned heel (Non articulated foot)
- Energy-absorbing cushion heel - permits PF in early stance
- Internal wooden keel that limits PF - eccentric control of DF
- Replaces a PF bumper to simulate eccentric contraction of DF in early stance
- Allows for:
- Sagittal plane motion (primarily PF)
- Very limited frontal plane motion (mediolateral motion)
- Used by:
- Limited ambulators
- Syme's amputees
Not used over uneven terrain for long-distance ambulation, or if energy conservation is needed
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Cushion heel in non-articulating feet permits what?
PF in early stance & allows for a small amount of mediolateral & transverse motion
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SAFE foot - 4
- Version of SACH
- Walking on moderately uneven terrain
- Mediolateral motion in rear-foot
- Prescribed for more active individuals
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What is it? What does it do?
- Seattle foot
- Slightly flexible plastic keel bends at heel contact
- Stores energy & recoils in late stance releasing energy
- Heavier than SACH
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Name type of socket
Patella tendon bearing socket
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P sensitive areas in PTB socket are where? - 4
- Anterior tibia + tibial crest
- Fibular head & neck
- Peroneal (fibular) nerve
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P tolerant areas in PTB socket - 4
- Patellar tendon
- Medial tibial plateau (flare)
- AT mm belly
- Distal end of tibia
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Name suspension; Used by who?
- Supracondylar wall suspension
- BKA
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Name suspension; Used by who
- Supracondylar/suprapatellar suspension
- Short residual limbs
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Friction mechanism is usually prescribed for who?
Older individuals who do not vary their gait speeds greatly
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Hydraulic/pneumatic knee units are prescribed for who?
Younger, more active individuals
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Prosthetic alignment: how?
- Knee center: posterior to TKA line
- Knee aligned farther posterior will be very stable (will not flex easily)
- May be prescribed for short residual limbs
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Name; Used by who?
- Quadrilateral socket
- AKA - long
- Medial & posterior wall - same height
- Anterior & lateral walls - 2.5-3 inches higher
- Has posterior shelf for ischial tuberosity & gluteals
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Quadrilateral socket reliefs - 4
- Adductor tendons
- Rectus femoris
- Gluteus maximus
- Hamstring tendons
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P sensitive areas AKA residual limb - 3
- Distolateral end of femur
- Pubic symphysis
- Perineal area
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P tolerant areas of AKA residual limb - 4
- Ischial tuberosity
- Gluteals
- Lateral sides of residual limb
- Distal end (rarely, may be sensitive)
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TSB (total surface bearing) socket for BKA
- Less prominent patellar shelf than seen in PTB
- Tries to distribute P more to other areas, taking P off tendon
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Name; Used by who?
- Supracondylar cuff
- Suspension for BKA prosthetics
- Soft leather bolted to med + lat sockets, goes up & circles fem condyles
- Pt who needs added suspension
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Name; Used by who?
- Silesian bandage
- A strap that anchors prosthesis by reaching around pelvis
- Controls for rotation
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Name; Used by who?
- Thigh corset - Suspension for BKA prosthetics
- Provides larger area for WB
- Individuals w/sensitive skin & unstable knee jt
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Supracondylar wall w/over knee sleeve - 4
- Suspension for BKA prosthetics
- Like a segment of a stocking to add suspension
- Sleeve is neoprene
- Good for vascular pts
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Extension aids - external vs internal
- External - Anterior - stretches in flexion so it can assist in extension
- Internal - Posterior - compresses in flexion to assist in ext
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Scarpa's bulge - 2
- Like popliteal bulge for BKA
- Pushes into Scarpa's triangle to help keep IT on IT shelf
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Name; Used by who?
- Ischial containment socket
- AKA - short
- Unlike quad socket, which has an IT shelf making IT carry most of load, this one tries to make a more symmetrical distribution of wt
- Looks rounder than rectangular quad
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Who shouldn't use ischial containment socket?
Vascular & renal pts w/stump size changing
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P in a BKA if foot is lateral leads to what kind of rotation?
- Prox & lat (at knee)
- Distal & med (at stump)
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P in a BKA if foot is too medial
- Prox & med (at knee)
- Distal & lat (at stump)
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Foot alignment - BKA vs AKA; When would you want it less offset from center for BKA?
- BKA - post/medial - for knee flexion & varus
- AKA - W/center of socket
- Shorter resid limb; More wt intolerant pt
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AKA socket - tilt how? why? (2); w/flexion contracture tilt how?
- Posterior 5 deg
- Makes P on IT more tolerant
- Helps w/post movement of limb in later stances
- Flexion contracture - tilt more posteriorly
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BKA socket - tilt how? Why? (1); w/hip flexion contracture tilt how?
- Anterior 5 deg
- Helps promote knee flexion during early stance
- Hip flexion contracture - tilt it more ant
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AKA - knee alignment; why?
- A bit post to plum line (trochanteric-ankle line)
- To build in extension stability (reduce impulse to buckle)
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Acceptable leg length differences btwn norm & prosthetic, BKA and AKA
- BKA - no more than 1/4 inch
- AKA - 1/2 inch, a bit more if it's a locked knee
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BKA socket is too far ant tilted - what gait dev?
Rapid & excessive knee flexion in early stance
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Desired shape for end of resid UE limb?
Oval, not circle
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Myodesis vs Myoplasty
- Myodesis = Attaching tendon to bone
- Myoplasty = Attaching mm to soft tissue
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Amputation - resistive exercises done when?
- When sutures are removed
- If not dissolving type, stay in 10-20 days
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Can you soak a residual limb?
No - it can lead to maceration
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One technique for addressing a hip flexion contracture
Lay prone
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PF bumper - where? limits what?
- Post
- PF
- It acts as eccentrically lengthening of DFs
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AKA - terminal swing impact - d/t what? - 1
Insufficient knee friction
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Transfemoral (AKA) – which sockets – 2
- Ischial containment
- Quadrilateral
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Socks - how many ply?
Not to exceed 15 ply
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