AMPUTATION Amputation Is defined as removal of the

AMPUTATION

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

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

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

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

Amputation levels

Amputation levels ( upper limbs ) • Hand & Partial-Hand Amputations Finger, thumb or portion of the hand below the wrist • Wrist Disarticulation Limb 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 Disarticulation Ambutation at the level of the shoulder, with the shoulder blade remaining. • Forequarter Amputation at the level of the shoulder in which both the shoulder blade and collar bone are removed

Amputation levels ( lower limbs ) • • • 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 Disarticulation Amputation occurs at the level of the knee joint Transfemoral Amputations (above knee ) Amputation occurs at any level from the hip to knee joint Hip Disarticulation Amputation is at the hip joint with the entire thigh and lower portion of the leg being removed.

After treatment 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

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

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

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

Lower Limb Prosthesis • 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)

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

Upper limb prosthesis

Cont …

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

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

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

Cont…

Cont…

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

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

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

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

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

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

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

Hip Abduction Orthosis Indications: • hip dislocation • post total hip replacement surgery

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

Hyper-Extension Spinal Orthosis 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

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

Post-op Knee Ranger 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

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

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

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