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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
Amputation at the level of the shoulder
in which both the shoulder blade and
collar bone are removed
Amputation levels ( lower limbs )
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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
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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 )
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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)
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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
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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)
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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
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Indications:
soft tissue repairs
stable elbow fractures
post dislocation
post subluxation
Elbow Orthosis
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Indications:
severe or chronic
elbow instability
trauma
post-operatively
immobilization
arthritis
muscle strength
imbalance