AMPUTATION

1. AMPUTATION

2. Amputation • Is defined as removal of the limb through a part of the bone Disarticulation : • Is the removal of the limb through the joint Note : injury is the most common cause for amputation

3. Cont … Incidence : • Age : 50 – 75 years • Sex : Male --75 % , Female : 25 % Limbs : • Upper limb : 15 % • Lower limb : 85 % Age VS indication : • Children ------- congenital anomalies • Young adults ----- injuries • Elderly -------- peripheral vascular disease

4. Indication Common causes : • Less than 50 years – injury • More than 50 years – peripheral vascular disease Less common causes : • Infection ( gas gangrene ) • Tumors • Nerve injuries • Congenital anomalies

5. Types Closed amputation : elective procedure • Skin is closed after amputation Open amputation : wound is left open over the amputation stump and is not closed • Done as an emergency procedure in the case of life – threatening infection ( severe infection , severe crush injury ) . Myodesis : muscle is sutured to the bone Myoplasty : muscle is sutured to the opposite muscle group under appropriate tension

6. Amputation levels

7. Hand & Partial-Hand AmputationsFinger, thumb or portion of the hand below the wrist Wrist DisarticulationLimb is amputated at the level of the wrist Transradial (below elbow amputations)Amputation occurring in the forearm, from the elbow to the wrist Transhumeral (above elbow amputations)Amputation occurring in the upper arm from the elbow to the shoulder Shoulder DisarticulationAmbutation at the level of the shoulder, with the shoulder blade remaining. Forequarter AmputationAmputation at the level of the shoulder in which both the shoulder blade and collar bone are removed Amputation levels ( upper limbs )

8. Foot Amputations Amputation of greater toes and other toes Amputation through the metatarsal bones Lisfranc`s operation : at the level of the tarsometatarsal joints Chopart`s operation : through the midtarsal joints Transtibial Amputations (below the knee) Amputation occurs at any level from the knee to the ankle  Knee DisarticulationAmputation occurs at the level of the knee joint Transfemoral Amputations (above knee )Amputation occurs at any level from the hip to knee joint Hip DisarticulationAmputation is at the hip joint with the entire thigh and lower portion of the leg being removed. Amputation levels ( lower limbs )

9. Rigid dressing concept : POP cast is applied to the stump over the dressing after surgery Advantage : Prevents oedema Enhance wound healing Decrease postoperative pain Reduce hospital stay Helps in early temporary prosthetic fiting Soft dressing concept : Stump is dressed with a sterile dressing and elastocrepe bandage are applied over it Bed is elevated to facilitate venous dranage and prevent stump oedema Suture are removed after 10 to 14 days and muscle exercise are commenced Prosthetic fitting is taken up as the last step After treatment

10. Complications • Haematomas ( delays the wound healing and acts as a culture media for the growth of the organism ) • Infections ( more common in peripheral vascular disease and DM ) • Necrosis ( due to insufficient circulation ) • Contractures ( preventable by positioning the stump properly ) • Phantom sensation ( pseudo feeling of the presence of the amputated limb ) • Causalgia ( Intense burning pain and sensitivity to the slightest vibration or touch ) : - due to division of the peripheral nerve

11. Prosthetic Prosthesis = in addition • It is defined as a replacement or substitution of a missing or a diseased part Classification Endoprostheses : implants used in orthopaedic surgery to replace joints Exoprostheses : replacement externally for a lost part of the limbs

12. Types Temporary prosthesis : • Used following an amputation till the patient is fitted with permanent prosthesis Permanent prosthesis

13. Lower Limb Prosthetic Aids are manufactured in fibreglass. These are fitted to following levels of amputations or loss: *Through Hip *Above Knee *Through Knee *Below Knee *Through Ankle (Symes) *Partial Foot (Chopart) Lower Limb Prosthesis

15. ABOVE THE KNEE PROSTHETIC SOCKETS Jaipur foot and below knee prosthesis.

16. Upper limb prosthesis

17. Cont …

19. Orthotics • Is an appliance which is added to the patient to enable better use of that part of the body to which it is fitted Action of orthosis : (FARSHVL ) • F --- free • A --- assist • R --- resist • S --- stop • H --- hold • V --- variable • L --- lock

20. Varieties of orhtoses • Spinal orthosis • Cervical orthosis • Lower limb orthosis • Upper limb orthosis

21. Spinal orthosis Functions : • To relieve pain • To support weakened paralysed muscles • To support unstable joints • To immobilise joints in functional position • To prevent deformity • To correct deformity

22. Cont…

23. Cont…

24. Indications: post-operative stabilization of the spine anterior compression fractures slippage of one vertebrae over another stable lumbar/thoracic fractures and musculoskeletal injuries Thoracic-Lumbar-Sacral Orthosis (TLSO)

25. Indications: post-operative stabilization of the spine lumbar vertebrae fractures chronic back pain slippage of one vertebrae over another stable lumbar fracture Lumbar-Sacral Orthosis (LSO)

26. Indications: patients with foot ulcers patients with insensate feet charcot joint (progressive degeneration of a weight bearing joint ) C.R.O.W. (Charcot Restraint Orthotic Walker)

27. Indications: foot deformity arthritis joint chronic painful skin lesion peripheral vascular disease neuropathy plantar fascitis Custom Foot Orthotics (FO)

28. Indications: knee instability ruptured ACL other knee ligament injury or rupture osteoarthritis (degenerative joint disease) Knee Orthosis (K.O.)

29. Indications: spina bifida cerebral palsy paraplegia polio trauma muscular dystrophy Knee Ankle Foot Orthosis (KAFO)

30. Indications: fractures, sprains, arthritis and trauma  stroke cerebral palsy spina bifida drop foot Ankle Foot Orthosis (AFO)

31. Indications: hip dislocation post total hip replacement surgery Hip Abduction Orthosis

32. Indications: C-1 to T-1 spinal immobilization cervical management Cervical-Thoracic Orthosis (CTO)

33. Indications: stable compression fractures of T-7 to L-2 needed thoracic extension to correct kyphotic posture thoracic instability needed extension or hyperextension for spinal alignment and reduce pain Hyper-Extension Spinal Orthosis

34. Indications: post-operative support acute and chronic low back pain compression fracture spinal stenosis spondylolysis spondylolisthesis Lumbar-Sacral Orthosis (LSO)

35. Indications: locked or limited motion control of knee during rehabilitation after operative procedures injury to knee ligaments or cartilage stable or internally fixed fractures of tibial plateau, condyles, or proximal tibia and distal femur Post-op Knee Ranger

36. Indications: stable fracture of foot and/or ankle severe ankle sprain post-operative use Walking Boot

37. Indications: soft tissue repairs stable elbow fractures post dislocation post subluxation Elbow Brace

38. Indications: severe or chronic elbow instability trauma post-operatively immobilization arthritis muscle strength imbalance Elbow Orthosis