Amputation and Limb Prostheses

Matthew Lee HMO2

Learning Issues
1. Background
2. Definitions 3. Anatomy

4. Mechanisms of trauma
5. Assessment of a mangled limb 6. Treatment options and indications for amputation 7. Limb prostheses

Background
Limb amputation is an uncommon and complex problem
90% of amputations are to the lower limb

Massive trauma is the second leading cause of amputation

Traumatic amputation affects young adults Amputation leads to significantly lower physical and social functioning

Definitions
Amputation = removal of a body extremity by surgery or trauma
Prosthesis = artificial extension that replaces a missing body part

Anatomy

Mechanisms of trauma
Miscellaneous, 13% Firearm, 2% Crush, 8% MBA, 28%

Pedestrian, 12%

Domestic, 13%

MVA, 24%

Assessment of the mangled limb

Mechanism (explosion penetrating low energy) Patients condition (clinical, laboratory)

Fracture characteristics
Soft tissue injury Vascular injury

Gustilo Classification for open tibial #

Indications for amputation

Lack of published evidence
RMH trauma guidelines (level IV and consensus)
Damage control surgery (clinical and laboratory parameters)

Complete disruption of tibial nerve

Massive crush injury (ischaemia >6hours) Near complete traumatic amputation with devascularisation or loss of muscle in all 4 crural compartments Massive contamination Associated mangled ipsilateral foot

Treatment options
1. Primary amputation (within 24 hours of injury)
2. Early secondary amputation (within 5/7 of injury) 3. Delayed secondary amputation (after first hospitalisation)

4. Limb salvage

Limb prostheses
1. Candidate selection
2. Prosthesis selection 3. Common problems

Candidate selection
Projected function
K level (0-3)

Amputation level and stump contour

Residual strength Prosthesis selection

General health

Medical comorbidities Cognition Vision Sensorimotor deficits

Prosthesis selection
Basic considerations
Comfort Ease of use Weight/durability Mechanics Cosmetics

Types

Preparatory Definitive

Function

Common problems
Pressure areas
Contractures Phantom sensation, phantom pain Choke syndrome Dermatological problems

Thank you