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AMPUTATION - PowerPoint PPT Presentation

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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 %

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  • 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

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

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 upper limbs
Hand & Partial-Hand AmputationsFinger, thumb or portion of the hand below the wrist

Wrist DisarticulationLimb 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 DisarticulationAmbutation at the level of the shoulder, with the shoulder blade remaining.

Forequarter AmputationAmputation at the level of the shoulder in which both the shoulder blade and collar bone are removed

Amputation levels ( upper limbs )
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 DisarticulationAmputation occurs at the level of the knee joint

Transfemoral Amputations (above knee )Amputation occurs at any level from the hip to knee joint

Hip DisarticulationAmputation is at the hip joint with the entire thigh and lower portion of the leg being removed.

Amputation levels ( lower limbs )
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

After treatment
  • 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

Prosthesis = in addition

  • It is defined as a replacement or substitution of a missing or a diseased part


Endoprostheses : implants used in orthopaedic surgery to replace joints

Exoprostheses : replacement externally for a lost part of the limbs


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)

Lower Limb Prosthesis
  • 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
Varieties of orhtoses
  • Spinal orthosis
  • Cervical orthosis
  • Lower limb orthosis
  • Upper limb orthosis
spinal 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
thoracic lumbar sacral orthosis tlso

post-operative stabilization of the spine

anterior compression fractures

slippage of one vertebrae over another

stable lumbar/thoracic fractures and musculoskeletal injuries

Thoracic-Lumbar-Sacral Orthosis (TLSO)
lumbar sacral orthosis lso

post-operative stabilization of the spine

lumbar vertebrae fractures

chronic back pain

slippage of one vertebrae over another

stable lumbar fracture

Lumbar-Sacral Orthosis (LSO)
c r o w charcot restraint orthotic walker

patients with foot ulcers

patients with insensate feet

charcot joint (progressive degeneration of a weight bearing joint )

C.R.O.W. (Charcot Restraint Orthotic Walker)
custom foot orthotics fo

foot deformity

arthritis joint

chronic painful skin lesion

peripheral vascular disease


plantar fascitis

Custom Foot Orthotics (FO)
knee orthosis k o

knee instability

ruptured ACL

other knee ligament injury or rupture

osteoarthritis (degenerative joint disease)

Knee Orthosis (K.O.)
knee ankle foot orthosis kafo

spina bifida

cerebral palsy




muscular dystrophy

Knee Ankle Foot Orthosis (KAFO)
ankle foot orthosis afo

fractures, sprains, arthritis and trauma 


cerebral palsy

spina bifida

drop foot

Ankle Foot Orthosis (AFO)
hip abduction orthosis

hip dislocation

post total hip replacement surgery

Hip Abduction Orthosis
cervical thoracic orthosis cto

C-1 to T-1 spinal immobilization

cervical management

Cervical-Thoracic Orthosis (CTO)
hyper extension spinal orthosis

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

Hyper-Extension Spinal Orthosis
lumbar sacral orthosis lso34

post-operative support

acute and chronic low back pain

compression fracture

spinal stenosis



Lumbar-Sacral Orthosis (LSO)
post op knee ranger

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

Post-op Knee Ranger
walking boot

stable fracture of foot and/or ankle

severe ankle sprain

post-operative use

Walking Boot
elbow brace

soft tissue repairs

stable elbow fractures

post dislocation

post subluxation

Elbow Brace
elbow orthosis

severe or chronic elbow instability





muscle strength imbalance

Elbow Orthosis