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11/7/2014 Professor Freih Abuhassan - University of
Jordan
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1- Strengthening and endurance program.
2- Continued psychological support.
3- Medical management of wound
healing and stump maturation.
4- Effective pain management.
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Jordan
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3 weeks after amputation1-Standing for short periods of time.
2-Interim Prosthesis at 5 to 6 W
3-Permanent prosthesis at 3 – 6m
4-Education of residual limb care.
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Jordan
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5-Education of prosthesis care.
6-Home exercise program continued.
7- Follow- up care by rehab. Medicine and prosthetist
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Jordan
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685 amputees
Knight and Urquhart (1989) study
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Jordan
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- 03% did not use a walking aid
- 17% walked with the aid of one stick
- 65% used two sticks
- 49% occasionally used, a wheelchair
- 40% required help using stairs
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Jordan
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- 30% reported difficulty walking indoors.
- 44% reported difficulties walking outside.
- 62% were able to wear their limbs for the
entire day .
- 38% pain was the primary reason
for not wearing the prosthesis.
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Jordan
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Functional disability associated with U.Limb amputation at all levels are not as great as might be expected.
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Usually less than a week of training in new techniques with use of adaptive devices is sufficient to restore
independence in most functions, even without a prosthesis.
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Amputation on the dominant side is more limiting.
Bilateral amputations
multiply problems.
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Jordan
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Long BKA 10%
Medium BKA 25%
Short BKA 40%
Average AKA 65%
Hip disarticulation 100%
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90% BKA will use prosthesis
25% AKA will use prosthesis
75% of bilat BKA will ambulate
< 25% of BK/AK will ambulate
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Jordan
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This group of individuals exhibit a high incidence of
M.I
CHF
Angina,
TIA attack,
Stroke.11/7/2014 13Professor Freih Abuhassan - University of
Jordan
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* A high M.R.
= BK 2-5%
= AK9-15%
= Revision 5-10%
* Polyneuropathy
* Retinopathy
* Nephropathy
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Any hematoma should be aspirated, and firm
compression should be applied to the stump
over the affected area.
(Necrosis )
If severe insufficient circulation at the level
of amp. wedge resection or re-amputation
at a more proximal level is necessary.
11/7/2014 16Professor Freih Abuhassan - University of
Jordan
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Incidence :12-28%
Related to indication of amp. (especialy in PVD, D.M), Clostridial infection:
2ry to perineal contamination
Prevention1-Staged amputation, decrease rate
from 22%2%
2-Peri-op. antibiotics (Gm+ &-)
3-Avoid stump hematoma
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Jordan
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1- Inadequate blood supply
2-Traumatic handling of tissues
3-Stump hematoma
4-Metabolic factors
albumin < 3.5
lymph count <1500/mm
BK= 15-20%, AK= 10-15%
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Jordan
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Prevented by
rigid dressing or knee immobilizer
If stump opens up needs re amp.
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Jordan
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Flexion contracture1= Proper positioning the stump
2= Early exercises to strengthen the muscles
and mobilize the joints
3= avoid pillow under the knee
4= rigid dressing
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Jordan
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Wound pain (N= 4-7 days)
Due to ischemic muscle or muscle necrosis
Phantom sensation ?!:the amputated part is still present. It is disturbing
Phantom pain
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Jordan
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A- Contracture , instability
1-Passive stretching of the joint,
2-Exercise to strengthen the muscles
controlling the joint.
1-
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B- Stiffness & deformity in proximal joint
e.g. after AKAabduction def. of hip
bec. adductor insertion removed while
abductors not disturbed .
Prevented by myoplasty or myodesis.
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1-Oedema due to prox.venous constr.
resulting from incorrect fitting
sockets
2-Unstable - too much soft tissue left
3-Failure to perform myodesis
2-
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=Pain originating in the amp. portion of the limb
=aching, burning, stabbing, or electrical sensations.
=Occurs in 90% of amputee
3-
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=> In young
=> After trauma
=?? Personality disorders
= Usually, decreases during the first 6-12 m after the amp.
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=If it last > 1 year, is likely to be permanent.
=The treatment of phantom pain is difficult and usually must contain behavioral and psychological components.
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1- Analgesics
2-Neuroleptics
3-Anticonvulsants
4-Tricyclic antidepressants
5-Beta –blockers
6-Sodium channel blockers11/7/2014 29Professor Freih Abuhassan - University of
Jordan
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1-T.E.N.S.
2-Percussion
3-Vibration
4-Massage
5-Acupuncture
6-Biofeedback
7-Hypnosis.
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The perception that the amp. limb is still present, but does not cause pain.
4-
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1-Regional nerve block
2-Sympathectomy
3-Neuroma excision
4-Dorsal root rhizotomy
5-Epidural spinal cord stimulation
6-Thalamic stimulation
Phantom limb
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=Neuromas occur any time a peripheral N. is cut.
=Axonal sprouts and buds grow at the end of the cut N.
=When these are subjected to mechanical trauma, pain occurs.
5-
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The pain is usually an electrical sensation that radiates in the peripheral N.
Rxreadjustment of the prosthetic
socket if failed the stump may have to be revised
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Usually mechanical irritation is caused by an ill-fitting socket.
• Fitting problemsas stump size changes with the time
6-
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DVT5-40% (contralateral leg)
=3-7 days P.Op.
=Prophylaxis is important.
7-
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=Redundancy - unstable muscle cushion.
=Bulbous stump
Due to excessive residual soft tissue
May need revision.
8-
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= Conical stumpesp in children as bone continues to grow
uncomfortable with pain.
= Spur formationdue to periosteal bone formation
Avoid periosteal stripping as it may
cause osteoporosis fracture
= Osteomylitis
9-
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-Poor vascular supply Cold blue stump with pain & ulceration
10-
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Eczema,
Ulceration require revision
at higher level
Blisters
Atrophy
Callosities
Allergic reactions to materials.
11-
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* Sitting asymmetry
* Bulbous stump
e.g Symes in females
* Severely scarred stump
12-
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11/7/2014 42Professor Freih Abuhassan - University of
Jordan