FINALS: Amputation

Question 1

Q: What is an amputation?

Answer 1

A: Surgical removal of part or all of a limb.

Question 2

Q: Differentiate congenital vs. acquired amputations.

Answer 2

Congenital: Due to malformation/absence from birth.

Acquired: Due to trauma, infection, or surgery.

Question 3

Q: What is the difference between terminal and intercalary absence?

Answer 3

Terminal: Loss of distal part (e.g., wrist/hand).

Intercalary: Loss of intermediate parts with proximal/distal parts preserved.

Question 3

Q: What is Amelia vs. Meromelia?

Answer 3

Amelia: Complete absence of limb(s).

Meromelia: Partial absence of a limb.

Question 3

Q: Transverse vs. Longitudinal limb deficiency?

Answer 3

Transverse: Limb ends at a certain level; no skeletal elements beyond it.

Longitudinal: Reduction/absence along the long axis (e.g., missing radius).

Question 4

Q: Most common etiology of LE amputation in adults?

Answer 4

A: Diabetes and PVD (75%).

Question 5

Q: Most common cause of amputation in children >5 y/o?

Answer 5

A: Trauma (70%).

Question 5

Q: What are the 3Ds indicating amputation?

Answer 5

Dead: Ischemic, gangrenous tissue.

Dangerous: Malignancy, sepsis.

Damned nuisance: Non-functional, painful, or unstable limb.

Question 6

Q: What are the types of surgical amputation?

Answer 6

Primary

Secondary

Late

Repeated/Reamputation

Question 7

Q: Criteria for salvage of an upper limb?

Answer 7

Good sensation

Durable soft tissue cover

Usable for interaction

Question 7

Q: Absolute indication for amputation?

Answer 7

A: Ischemia in a limb with non-reconstructable vascular injury.

Question 8

Q: What is the most common UE amputation?

Answer 8

A: Transradial (below elbow).

Question 8

Q: Common LE amputation levels?

Answer 8

A: Toe, Ray, Transmetatarsal, Transtibial, Transfemoral, Hip disarticulation, Hemipelvectomy.

Question 11

Q: What is Syme’s amputation?

Answer 11

A: Ankle disarticulation preserving heel pad for end weight-bearing.

Question 12

Q: What is Pirogoff’s procedure?

Answer 12

A: Osteotomy and fusion of calcaneus to distal tibia.

Question 12

Q: What is Boyd’s amputation?

Answer 12

A: Tibiocalcaneal fusion with full heel pad preservation.

Question 13

Q: What is myoplasty vs. myodesis?

Answer 13

Myoplasty: Muscle to muscle attachment.

Myodesis: Muscle to periosteum/bone attachment.

Question 14

Q: Non-drug management for phantom pain?

Answer 14

A: TENS, stump manipulation, physiotherapy, acupuncture, DREZ operation.

Question 14

Q: What is phantom limb pain?

Answer 14

A: Pain in the area of the removed limb, often shooting/burning.

Question 14

Q: Rate of phantom limb pain post-amputation?

Answer 14

A: Affects 50–75%, usually within 1 week post-op.

Question 15

Q: What is a guillotine amputation?

Answer 15

A: Emergency amputation where skin, muscle, and bone are divided at the same level.

Question 16

Q: Best post-op dressing for edema control?

Answer 16

A: Rigid dressing (IPOP) – limits swelling, reduces pain.

Question 17

Q: What is a shrinker?

Answer 17

A: A compression sock used post-op to shape the residual limb for prosthesis.

Question 18

Q: Common dermatologic issues in stumps?

Answer 18

A: Folliculitis, dermatitis, hyperhidrosis, skin breakdown.

Question 19

Q: Criteria for reamputation?

Answer 19

Bone overgrowth Ulceration Painful neuroma Skin breakdown Sepsis or pseudoarthrosis

Question 20

Q: What are the goals of amputation surgery?

Answer 20

A: Preserve length, maintain sensibility, avoid neuroma, prevent contractures, allow early prosthetic use, restore function.

Question 21

Q: What are the types of prostheses?

Answer 21

Cosmetic Functional Body-powered Myoelectric

Question 22

Q: What are characteristics of a successful prosthesis?

Answer 22

A: Comfortable, easy to use, functional, durable, cosmetic, and aligned with patient motivation.

Question 23

Q: When should a passive upper limb prosthesis be introduced in pediatrics?

Answer 23

A: At 3–4 months of age.

Question 24

Q: At what age can a child use a body-powered terminal device?

Answer 24

A: 14–18 months (attention span >10 min, can follow commands).

Question 24

Q: What is the Ertl procedure?

Answer 24

A: Osteomyoplastic transtibial amputation creating a tibia-fibula bone bridge to enhance end-bearing and stability.

Question 24

Q: What is Krukenberg’s procedure?

Answer 24

A: Forearm split to create functional forceps using radius and ulna; sensory, muscle-powered, ideal for bilateral blind amputees.

Question 24

Q: What are indications for Krukenberg procedure?

Answer 24

A: Bilateral transradial, motivated, with preserved radius/ulna and <70° elbow contracture.

Question 24

Q: What are the requirements to fit a LE prosthesis?

Answer 24

A: Trunk control, upper body strength, balance, good posture.

Question 24

Q: When can prosthetic elbow control begin in children?

Answer 24

A: 3–4 years old.

Question 24

Q: What is the management strategy for lower limb prosthetics in children?

Answer 24

Sitting balance: by 6 months Weight bearing: by 9–10 months Knee joint training: 2.5–4 years Modify prosthesis: yearly until age 5, every 2 years until 12

Question 25

Q: What factors affect prosthesis selection?

Answer 25

A: Level of amputation, cognitive ability, vocation, hobbies, cosmetic needs, finances.

Question 25

Q: What makes wrist disarticulation favorable in pediatrics?

Answer 25

A: Preserves distal physes, improves pronation/supination, long lever arm.

Question 25

Q: What is a Pirogoff amputation?

Answer 25

A: Hindfoot amputation with calcaneus rotated and fused to tibia.

Question 25

Q: What are the components of a lower limb prosthesis?

Answer 25

A: Socket, liner, suspension, joint, pylon, and terminal device (usually a foot).

Question 26

Q: What is a Syme’s amputation?

Answer 26

A: Ankle disarticulation preserving heel pad for weight-bearing.

Question 26

Q: What is a Boyd amputation?

Answer 26

A: Fusion of calcaneus to tibia, preserving the heel for weight-bearing.

Question 27

Q: What is the ideal level for transradial amputation?

Answer 27

A: Middle third of the forearm to preserve function and prosthetic fit.

Question 28

Q: What is the main difference between preparatory and definitive prosthesis?

Answer 28

A: Preparatory allows for early fitting; definitive is final and fitted after full healing.

Question 29

Q: Why is elbow disarticulation favored in children?

Answer 29

A: Reduces risk of bone overgrowth compared to transhumeral.

Question 30

Q: What causes heterotopic ossification?

Answer 30

A: Often trauma-related; bone growth in soft tissue post-amputation.

Question 30

Q: What is mirror therapy used for?

Answer 30

A: Non-invasive treatment of phantom pain using visual feedback.

Question 31

Q: What is choke syndrome?

Answer 31

A: Edema and pain due to prosthetic suction, leading to soft tissue compression and breakdown.

Question 31

Q: What are risk factors for post-op infection in traumatic amputations?

Answer 31

A: Open wounds, contamination, poor vascularity—up to 34% risk.

Question 32

qQ: What dressing helps reduce post-op edema?

Answer 32

A: Rigid dressing (e.g., IPOP) and shrinkers.

Question 33

Q: What is Gritti-Stokes amputation?

Answer 33

A: Through-femur amputation with patella fused to femur for improved end-bearing.

Question 34

Q: What are the energy costs of various amputations?

Answer 34

BKA: +25–40% AKA: +68–100% Bilateral AKA: >200% Syme’s: +15% (most efficient for distal amputations)

Question 35

Q: What is the significance of the ankle-brachial index (ABI) in healing?

Answer 35

A: ABI > 0.45 suggests potential for healing; < 0.2 indicates poor prognosis.