Which type of deformity is the most likely complication of this procedure?
A 70-year-old female with a history of poorly controlled diabetes mellitus presents with purulent ulcers along the plantar aspect of her right forefoot and exposed metatarsal bone.
amputations are done urgently and electively to reduce pain, provide independence, and restore function, prevention of adjacent joint contractures, early return of patient to work and recreation, 1.7 million individuals in the United States with an amputation, 80% of amputations are performed for vascular insufficiency, Amputations may be indicated in the following, most common reason for an upper extremity amputation, most common reason for a lower extremity amputation, perform amputations at lowest possible level to preserve function, Syme amputation is more efficient than midfoot amputation, inversely proportional to length of remaining limb, Ranking of metabolic demand (% represents amount of increase compared to baseline), varies based on patient habitus but is somewhere between transtibial and transfemoral, most proximal amputation level available in children to maintain walking speeds without increased energy expenditure compared to normal children, measurement of doppler pressure at level being tested compared to brachial systolic pressure, pressure-sensitive implanted medical device (automatic implantable cardiac defibrillator, pacemaker, dorsal column stimulator, insulin pump), Amputation versus limb salvage and replantation, mangled upper extremity has a far greater impact on overall function than does a lower extremity amputation, upper extremity prostheses have much more difficulty replicating native dexterity and sensory feedback provided by the native limb, results of nerve repair and reconstruction are more successful in upper extremity than lower extremity, superior functional outcomes can be expected in replanted limbs compared with upper extremity amputations, diminishing outcomes from replantation are expected the more proximal the level, especially about the elbow, wrist disarticulation or transcarpal versus transradial amputation, recommended in children for preservation of distal radial and ulnar physes, can be difficult to use with highly functional prosthesis compared to transradial, Although, this may be changing with advancing technology, easier to fit prosthesis (myoelectric prostheses), transhumeral versus elbow disarticulation, indicated in children to prevent bony overgrowth seen in transhumeral amputations, All named motor and sensory branches within operative field should be identified and preserved, can result in improved muscle mass and preserve the ability to create myoelectric signal for targeted reinnervation, myodesis, the process of attaching the muscle-tendon unit directly to bone is recommended, anchor wrist flexor/extensor tendons to carpus, middle third of forearm amputation maintains length and is ideal, residual 5cm of ulna is required for elbow motion, but at this level will have limited pronation/supination, ideal level is 4-5cm proximal to elbow joint, At least 5-7cm of residual length is needed for glenohumeral mechanics, retain humeral head to maintain shoulder contour, designed to improve control of myeolectric prostheses used for amputation, transfer amputated large peripheral nerves to reinnervated functionally expendable remaining muscles to create a new discrete muscle signal for the myoelectric prosthesis control, secondary benefit of alleviating symptomatic neuroma pain, however, ideal cut is 12 cm (10-15cm) above knee joint to allow for prosthetic fitting, 5-10 degrees of adduction is ideal for improved prosthesis function, creates dynamic muscle balance (otherwise have unopposed abductors), provides soft tissue envelope that enhances prosthetic fitting, amputation through the femur near level of adductor tubercle, synovium is excised to prevent postoperative effusion, patella is arthrodesed to the end of femur for improved end bearing, prepatellar soft tissue is maintained without iatrogenic injury, improved outcomes as compared to transfemoral amputation, ambulatory patients who cannot have a transtibial amputation, suture patellar tendon to cruciate ligaments in notch, use gastrocnemius muscles for padding at end of amputation, Consequence of poor soft tissue envelope from loss of gastrocnemius padding, 12-15 cm below knee joint is ideal (10-16cm of residual tibia bone), longer than this gets into the achilles tendon which has a suboptimal blood supply and ability for soft tissue cushioning, need approximately 8-12 cm from ground to fit most modern high-impact prostheses, preventable with well-designed incision lines, preserve blood supply to the posterior flap, designed to enhance prosthetic end-bearing, argument is that the bone bridge will enhance weight bearing through the fibula and increase total surface area for load transfer, increased reoperation rates have been reported, the original Ertl amputation required a corticoperiosteal flap bridge, the modified Ertl uses a fibular strut graft, requires longer operative and tourniquet times than standard BKA transtibial amputation, fibula is fixed in place with cortical screws, fiberwire suture with end buttons, or heavy nonabsorbable sutures, used successfully to treat forefoot gangrene in diabetics, medial and lateral malleoli are removed flush with distal tibia articular surface, the medial and lateral flares of the tibia and fibula are beveled to enhance heel pad adherence, removal of the forefoot and talus followed by calcaneotibial arthrodesis, calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal, allows patient to mobilize independently without use of prosthetic, Chopart or Boyd amputation (hindfoot amputation), a partial foot amputation through the talonavicular and calcaneocuboid joints, avoid by lengthening of the Achilles tendon and, leads to apropulsive gait pattern because the amputation is unable to support modern dynamic elastic response prosthetic feet, unopposed pull of tibialis posterior and gastroc/soleus, prevent by maintaining insertion of peroneus brevis and performing achilles lengthening, a walking cast is generally used for 4 week to prevent late equinus contracture, Energy cost of walking similar to that of BKA, more appealing to patients who refuse transtibial amputations, almost all require achilles lengthening to prevent equinus, preserves insertion of plantar fascia, sesamoids, and flexor hallucis brevis, reduces amount of weight transfer to remaining toes, prevent with early aggressive mobilization and position changes, trauma-related amputation have an infection rate of around 34%, prevent with proper nerve handling at the time of procedure, a method of guiding neuronal regeneration to prevent or treat post-amputation neuroma pain and improve patient use of myoelectric prostheses, occurs in 53-100% of traumatic amputations, mirror therapy is a noninvasive treatment modality, most common complication with pediatric amputations, prevent by performing disarticulation or using epihphyseal cap to cover medullary canal, Outcomes are improved with the involvement of psychological counseling for coping mechanisms, Involves a close working relationship between rehab physicians, prosthetists, physical therapists, as well as psychiatrists and social workers, High rate of late amputation in patients with high-energy foot trauma, highest impact on decision-making process, 2nd highest impact on surgeon's decision making process, plantar sensation can recover by long-term follow-up, SIP (sickness impact profile) and return to work, mangled foot and ankle injuries requiring free tissue transfer have a worse SIP than BKA, most important factor to determine patient-reported outcome is the ability to return to work, About 50% of patients are able to return to work, study focused on military population in response to LEAP study, slightly better results in regard to patient-reported outcomes for the amputation group with a lower risk of PTSD, more severe limbs were going into salvage pathway, military population with better access to prostheses, higher rates of return to vigorous activity in the amputation group, Descending thoracic aorta graft, with or without bypass, Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency. A 34-year-old male sustains a traumatic injury to his foot following a motorcycle accident. 
(OBQ10.2)
Although it is viewed as a last resort after illness or injury, it is sometimes unavoidable. 0000097491 00000 n
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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
0000002706 00000 n
After multiple attempts at limb salvage, the family and treating surgeon elect to proceed with a knee disarticulation. 0000002534 00000 n
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A radiograph of the chest shows a small pneumothorax which is being observed and does not require a thoracostomy tube.
What important step was forgotten during the amputation?
There are 3 basic types of transradial prostheses: After amputation, its important to take good care of your arm and the incision site in order to ensure a full recovery.
The radius is one of the 2 long bones that make up your forearm, running from the wrist to the elbow. hbbd``b` $/@]HIXX} b " VnisR@B
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Improved performance on the Sickness Impact Profile (SIP) questionnaire, Physicians were more satisfied with the cosmetic appearance, Decreased dependence with patient transfers.
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0000122415 00000 n
A 65-year-old diabetic male with forefoot gangrene is evaluated for possible amputation. She is insensate to the midfoot bilaterally. Which one of the following lower extremity amputations requires a soft-tissue balancing procedure to prevent deformity following amputation? (OBQ07.6)
This damage may be caused by a tumor, frostbite, or a serious infection. 0000003601 00000 n
(OBQ04.275)
In fact, many patients are able to regain the use of their damaged limbs and lead relatively normal lives.
(OBQ09.201)
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In addition to lengthening the Achilles, transfer of which tendon is most important for functional ambulation after performing a Chopart amputation of the foot?
This is an AAOS Self Assessment Exam (SAE) question. (OBQ04.235)
(OBQ08.246)
A cosmetic prosthesis is for appearance only and does not move. 0000123109 00000 n
Type in at least one full word to see suggestions list, Bobby Menges Memorial HSS Limb Deformity Course 2020, Osseointegration Femur - S. Robert Rozbruch, MD, Osseointegration Tibia - Kevin Tetsworth, MD, Intertrochanteric Fracture Proximal to Above Knee Amputation.
0000002825 00000 n
(OBQ06.218)
0000032919 00000 n
However, because of modern advances in surgery and prosthetic devices, amputation does not have to become a permanent handicap. Operative debridement and irrigation within 1 hour of injury.
She elects to undergo an amputation.
Regarding Syme amputations, which of the following is true? Myodesis of which muscle group is most important for optimal outcome after transfemoral amputation? 0000003638 00000 n
Close to 2 million Americans are living with some type of amputation. It connects an electronic hand to the muscles in your arm. 0000004120 00000 n
0
0000005847 00000 n
After amputation, you will most likely be fitted with some type of prosthetic.
tenodesing the extensor digitorum longus to the tibial shaft.
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A physical therapist will help you learn to use your artificial arm so that you can perform your normal activities and take care of yourself with your new prosthesis.
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What technical error is the most likely cause of his dysfunction?
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When discussing the amputation levels with the patient, which of the following should be noted to require the greatest increase in energy expenditure for ambulation?
0000003369 00000 n
Transradial amputation is the partial amputation of the arm below the elbow, at some point along the radial bone.
0000006418 00000 n
Six months after the amputation he has persistent difficulty with ambulation because his distal femur moves into a subcutaneous position in his lateral thigh.
A radiograph is shown in Figure B. 966 0 obj
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As a result, his energy expenditure while ambulating is 40% above baseline after being fitted with an appropriate prosthetic prescription. 0000002253 00000 n
0000023984 00000 n
0000010133 00000 n
(OBQ18.31)
For an above knee amputation, each of the following is a benefit of adductor myodesis EXCEPT: Allows preservation of greater femoral length, Provides a soft tissue cushion beneath the osseous amputation, Improves the position of the femur to allow more efficient ambulation, Creates dynamic balance of the amputated femur. Which of the following has the most impact on the decision to attempt limb salvage versus amputation?
0000002585 00000 n
Preserving the soft-tissue envelope (peroneus brevis, tertius and plantar fascia) around the fifth metatarsal base, Myodesis of the anterior tibialis to the medial and middle cuneiforms, Lengthening of the gastrocsoleus (achilles tendon). 373 0 obj
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He undergoes transfemoral amputation.
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0000008725 00000 n
Which of the following is true of a knee disarticulation as compared to a transtibial amputation? 0000079743 00000 n
(OBQ06.145)
It does not require a patent tibialis posterior artery, It is less energy efficient than a midfoot amputation, The primary complication is an equinus deformity, It is also known as a hindfoot amputation. Once your arm is sufficiently healed, you can be fitted forprosthetics in Memphis, TN. Transfemoral ProsthesisTranstibial ProsthesisTranshumeral ProsthesisTransradial Prosthesis, 266 S Cleveland St. Ste 102
What is the most proximal level of amputation that a child can undergo and still maintain a normal walking speed without significantly increasing their energy cost?
(OBQ04.227)
(OBQ05.150)
0000010822 00000 n
A through-knee disarticulation has been shown to have what advantage over a traditional above-knee (transfemoral) amputation? Men who are 20-40 years old are the most commonly affected, but also have a high rate of successful recovery.
You may also temporarily experience phantom pains or sensitivity.
0000122646 00000 n
If the bones in the arm are shattered or broken beyond repair, it is sometimes necessary to amputate so that disease does not set in and travel to the rest of the body.
0000005990 00000 n
(OBQ12.171)
Memphis TN 38104 |, Toenail Clippers Dangerous Weapon for Diabetics.
0000003064 00000 n
(OBQ12.219)
A 45-year-old diabetic woman with a gangrenous foot undegoes a Chopart amputation without tendon transfer or lengthening. The site will initially be very swollen and painful and will need to be cleaned frequently to prevent a bacterial infection. (OBQ13.81)
0000096549 00000 n
A 33-year-old man requires a transfemoral amputation because of a mangling injury to his leg.
0000011488 00000 n
0000023901 00000 n
Further preoperative evaluation demonstrates a transcutaneous oxygen pressure of 45 and an albumin of 3.4.
0000020516 00000 n
During this time, your doctor will give you exercises to perform that will help strengthen your arm and torso, making it easier to adapt to your artificial limb.
A conventional (or body-powered) prosthesis is connected to the body by a series of cables. Three months later the patient presents to the office with the limb sitting in an abducted position.
(OBQ09.13)
0000003279 00000 n
Tight posterior capsule tissues of the ankle, Unopposed pull of gastrocnemius-soleus only, Unopposed pull of gastrocnemius-soleus, posterior tibialis, and peroneus brevis, Unopposed pull of gastrocnemius-soleus and posterior tibialis.
0000079037 00000 n
ABI of 0.4 for the posterior tibial artery. 0000002168 00000 n
Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. This type of surgery leaves your elbow and most of your arm intact, which makes recovery easier and makes it more likely that you will be able to continue to use your arm even after the amputation. Which of the following deformities is most common after the amputation shown in Figure A?
startxref
A myoelectric prosthesis is the newest and most advanced form of transradial prosthesis. 0000079578 00000 n
(OBQ10.145)
Which of the following is most important to achieve a good outcome following a Syme amputation? 0000042267 00000 n
0000097409 00000 n
(OBQ06.53)
(OBQ10.162)
His history is significant for COPD, diabetes controlled with an insulin pump, and testicular cancer treated with bleomycin twenty years ago.
0000000016 00000 n
(SAE08OS.13)
Allowing the sciatic nerve to retract deep into the soft tissue. Which of the following amputations results in an approximate 40% increase in energy expenditure for ambulation? The patient's neurovascular status necessitates the amputation demonstrated in figures A through C. One year following the amputation, the patient complains of difficulty with gait and deformity of the ankle. (OBQ05.271)
Less postoperative time to final prosthesis fitting. 0000005050 00000 n
317 57
What is this patient's most likely lower extremity amputation level?
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0000021079 00000 n
Which of the following is not a contraindication to hyperbaric oxygen treatment for this patient? By moving your body in different ways, it is possible to move the prosthesis and even open and close the artificial hand. It persists despite a well-fitted prosthesis.
0000001436 00000 n
Your doctor will show you how to apply a compression wrap to the area to help reduce swelling and promote healing. 0000021229 00000 n
0000123474 00000 n
0000003506 00000 n
0000096314 00000 n
Removal of the "dog ears", indicated by the red arrows, could cause direct damage to what vasculature leading to flap necrosis? 0000007144 00000 n
0000123843 00000 n
Which of the following would be a contraindication to performing a Syme amputation (ankle disarticulation) in this patient?
A 40-year-old male who sustained an open pilon fracture 2 weeks ago is scheduled for a below-the-knee amputation (BKA).
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Which of the following amputations will lead to the greatest oxygen requirement per meter walked following prosthesis fitting?
0000006566 00000 n
(OBQ06.230)
hb```LF 9 b)
%kl$7I^znv6c`EyuQY!X. During a Lisfranc (tarsometatarsal) amputation of the foot, which of the following is crucial to prevent the patient from having a supinated foot during gait.
A 34-year-old male is an inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle collision.
A 37-year-old man presents to the emergency room with the left lower extremity injury shown in Figure A.
At other times, a doctor might decide amputation is necessary because of other damage to your hand or lower arm.
Which of the following statements best describes the forces resulting in this deformity?
Figure A shows a below the knee amputation performed in a diabetic patient with significant vascular disease. 0000033229 00000 n
A 66-year-old male sustains an open crush injury to his right lower leg with significant skin loss.
0
0000009467 00000 n
In some cases, a birth defect may be amputated if it causes constant pain.
A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable.
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