Professional Documents
Culture Documents
What is a disarticulation?
Amputation performed through a joint
Congenital Amputations
Causes:
Intrauterine development
Hereditary
Teratogenic agents
Maternal diabetes
Adactylia
Absent digit
Apodia
Absent foot
Phocomelia
Transverse total humeral radial , ulnar
deficiency
Percentages
Above Elbow
0% - Shoulder Disarticulation
0-30% - Humeral Neck
30-50% - Short Above Elbow
50-90% - Long Above Elbow
Below Elbow
0-35% very short below elbow
35-55% short below elbow
55-90% long below elbow
90-100% wrist disarticulation
`
Below knee
Stump Length
From medial tibial plateau to end of
bone
Normal Length
From medial tibial plateau to medial
malleolus
Below knee
8 to 18 cm or 5 to 7 inches below medial
tibial plateau.
Sullivan
Transtibial
>50% of tibial length long below knee
20-50% - below
<20% of tibial length short below knee
Preoperative
Evaluation and Assessment
Emotional Counseling
Therapy Counseling
Operative Management
The cardinal rule is to preserve as much as
length as possible.
Avoid the following level:
Hindfoot
Distal 1/3 of the leg
Supracondylar of femur
Skin closure
Above knee amputee-fish mouth or middle
flap.
Below knee amputee-posterior flap/anterior
suture.
Post-Operative Management
Healing of wounds
Pain control
Preparation for prosthetic fitting
Maintenance of range of motion
Independent mobility
Independent self-care
Post-Operative Dressing
Rigid
Made of Plaster of Paris
Change every 5-10 days.
Advantages
Limits post-operative edema
Allows for early ambulation
Reduces length of time for shrinking
Disadvantages
Requires careful application
Requires close supervision
Does not allow early wound inspection
Semi-Rigid
The Unna Paste Dressing
A compound of zinc oxide, gelatin, glycerin and
calamine maybe applied in the operating room.
Advantage
Better control of edema
Disadvantage
May loosen easily
Soft Dressing
Oldest method of post-surgical management
of residual limb.
Advantage
Inexpensive
Lightweight and readily available
Easily laundered
Disadvantage
Poor control of edema
Requires skill of application
Need frequent reapplication
Can slip and form a torniquet
Uneven terrain-stairs-ramps-curbs
Falling and getting-up
Transfer activities.
50%
9%
Class III
Self-Care Plus
The individual is disabled and has physical
limitation, requires frequent adjustment of
prosthesis.
Class IV
Self-Care Minus
Needs help from others because he is
severely disabled. Cannot go up and down
the stairs without assistance.
Class V
Cosmetic Plus
The amputee is better off without a prosthesis
Class VI
Not feasible. Only a wheelchair is prescribed.
End of Lecture