1
Q
Transhumeral Cabling System
A
Fair Lead
- Split Cable housing
2
Q
Transradial Cabling System
A
Bowden
- Single Cable Housing
3
Q
Krukenberg Amputation
A
- bilateral transradial amputations
- visually impaired
4
Q
Anterior Cruciate Ligament
A
- back and forth motion of the knee
- posterior lateral distal femur to anterior medial proximal tibia
5
Q
Posterior Cruciate Ligament
A
- posterior stabilizer of the knee
- anterolateral aspect of the medial femoral condyle to posterior aspect of tibial plateau
6
Q
Upper Prosthetic Limb Length
A
Lateral epicondyle to thumb tip
7
Q
Figure of 9 Harness
A
Terminal device activation only
8
Q
Figure of 8 Harness
A
Suspension needed
Terminal device function
9
Q
Rigid Hinge: Single-Axis
A
- protects RL from excessive torque loads
- extension stop prevents elbow hyperextension
10
Q
Wrist Shapes
A
- Circular base more anatomical (WD or Long transradial)
- Oval base (mid length to short transradial)*
11
Q
Step Up Hinge
A
- 2:1 ratio between forearm and residual limb
- requires 2x the force to fully operate
12
Q
Flail Arm Hinge
A
- brachial plexus injury
- ROM is present, strength not present
13
Q
Flexible Hinges
A
- medium to long TRs
- allow pronation/supination
- do not protect against torque
14
Q
Required excursion to fully open TD from fully closed position:
A
2 inches
15
Q
UE Self-Suspending Sockets
A
- prevent rotation by surrounding the medial and lateral epicondyles of the elbow
- northwestern, Otto bock, muenster
16
Q
Long Transradial Shape
A
- ellipsoidal shape
- can prevent socket rotation
- screw-driver effect
17
Q
Short Transradial Shape
A
- circular
- allows axial rotation
18
Q
UE Self-Suspension Styles
A
- Supra-styloid (allows axial rotation)
- Supra-epicondylar (prevents axial rotation)
19
Q
Elbow disarticulation amputation
A
- Humerus remains generally intact along with articular cartilage
- May include moderate contouring of the humeral condyles
- Soft tissue distally should be minimized for suspension/rotational control via humeral condyles
20
Q
RL Length for Elbow Disarticulation
A
Max elbow discrepancy - 2 inches
21
Q
Transhumeral Shape
A
- “D” shape in axilla
- Round in mid-humeral region
- Bulbous asymmetric shape at distal end
22
Q
Dual Control System
A
Fair-Lead Split Housing (two-piece)
- Elbow flexion 2.5”
- Complete TD opening 2”
Elbow Lock cable
- 5/8”-3/4” excursion
- 2 lbs. force
23
Q
Forearm Lift Tab Jig Operation
A
- closer to the elbow axis, more body power required, but cable excursion decreases
- farther away from the elbow axis, less body power required, but cable excursion increases
- initial placement: 3rd hole distal to the elbow axis on the bottom row
24
Q
Humeral Base Plate Placement
A
- Middle of the humeral socket
- 50% or longer than the anatomical length
- Distal end of inner socket
- shorter than 50% of anatomical length
*Minimizes “adduction” torques on the px
25
Transhumeral Control Motion Sequence
- flex elbow to desired ROM
| - lock elbow shoulder: depression, extension, and abduction
26
Carlyle Index (Bilateral Arm Amputee)
- Upper-arm px length = height (in) x 0.19
| - Forearm px length = height (in) x 0.21
27
Forearm Lift Assist
- placed on the medial side to allow patient adjustment
| - ideal for short ?? and shoulder disarticulations due to limited force generation secondary to weakening or pain
28
Excursion Amplifier
- 2x the force input generates 2x the excursion
| - mount to posterior brim of socket
29
Shoulder Disarticulation/IST Disadvantages
- pressure sensitive
- excursion generation
- balance (arm ~ 4.9% of body weight)
30
Knee Joint
Polycentric hinge - rolling and sliding action
- Med Roll: first 10-15 degrees
- Lat Roll: roll for 20 degrees
31
Screw-Home Mechanism
Tibia
- internal rotation during knee flexion
- external rotation during knee extension
32
KAFO Clearance Guidelines
```
Perineum (30 mm or ~ 1")
Knee
- Medial: 6 mm
- Lateral: 3 mm
- Drop Locks: 3 mm
Ankle (Ht.: Apex of lateral malleolus)
- Medial: 6 mm
- Lateral: 5 mm
```
33
Cervical Vertebrae Characteristics
- Transverse foramen present for blood supply
- Vertebral foramen is large and triangular
- C3-C6 have bifid spinous processes
34
Thoracic Vertebrae Characteristics
- Spinous process is spine like and is close to vertical
| - Body is heart shaped
35
Lumbar Vertebrae Characteristics
- Spinous process is large, oblong and horizontal
- Vertebral foreman is small and triangular
- Body is kidney-shaped and longer transversely
36
Intertransverse Ligament
- Connect transverse processes
| - Assist in controlling lateral bending
37
Spondylolysis
Bony defect at the pars interarticularis, which may be unilateral or bilateral.
38
Spondylolisthesis
Forward slippage of one vertebrae upon the other. (L5)
39
Jefferson's Fracture (Diving Accident)
- 4 part burst fracture of Atlas (C1)
| - axial compression, hyperextension
40
Odontoid Fracture
- Type I Avulsion of alar lig. off one side of tip of dens.
- Rigid Collar
```
Type II (most common) Fx through base of odontoid via hyper flex or ext
- Halo
```
Type III FX extends through body of C2
- Halo
41
Hangman's Fracture
- Fx of pars interarticularis of C2
| - Forceful extension of extended neck
42
Chance Fracture
- "seatbelt" injury mechanism
43
Spinal Orthosis Selection: T7-L3
TLSO Corset - Custom TLSO
44
Spinal Orthosis Selection: L1-L3
LSO Corset - Custom LSO
45
Spinal Orthosis Selection: L4-S1
LSO Corset - LSO Fracture Cast w/ Spica
46
Adams Forward Bending Test
- Spinous process rotate to the curve's concavity, vertebral bodies to the convexity.
- Thoracic: Rib prominence
- Lumbar: Paraspinal prominence
47
Scheuermann's Kyphosis
- interruption of endochondral ossification, leading to anterior wedging and increased kyphosis
- typical presentation around ages 10 to 12
- marked increase kyphosis upon forward bending
48
Zig Zag Deformity
- Radial deviation
| - Rheumatoid arthritis
49
Buerger's Disease
- Acute inflammation and thrombosis (clotting) of arteries and veins
- Affects the hands and feet
- 20-40 y. o. male cigarette smokers
50
Syme PTB Mod. Location
Lower than TB
| - Heel off forces are on the patellar tendon instead of the on the crest of the tibia.
51
Anterior - Posterior
| TB PTB Socket Forces
- popliteal
| - distal tibia
52
Medial - Lateral
| TB PTB Socket Forces
- medial tibial flare
| - distal lateral socket
53
Adduction
| TB Prosthetic Alignment
- distal medial increase
| - varus knee
54
Abduction
| TB Prosthetic Alignment
- distal lateral increase
| - valgus knee
55
Px Joint and Corset Goals
- redistribute some residuum pressure on to thigh
- increase ML knee stability
- prevent genu recurvatum
- suspension (waste belt and fork strap)
56
TB Px Joint Attachment
- 2.25" proximal to MPT
| - Socket midline
57
TB Px Corset Clearance
- 1" clearance between distal posterior aspect of the corset relative to the socket while sitting at 90 degrees
58
TB Endoskeletal Construction
Indications
- need for interchangeability of components
Advantages
- alignment adjustability after fabrication
Disadvantages
- requires more maintenance
59
TB Exoskeletal Construction
Indications
- appropriate for virtually all def. BK prostheses whether usage will be light or heavy duty
Advantages
- easy to keep clean
Disadvantages
- alignment is not adjustable without major fabrication
60
PTB Socket w/ Soft Liner
Advantages
- soft protective socket interference
- appropriate for the majority of residual limbs
Disadvantages
- not as hygienic as a hard socket
- increases bulk around the knee
61
PTB Hard Socket
Advantages
- less bulky at the knee than with an insert
- easy to keep clean
Disadvantages
- requires precision in casting and modification
62
Supracondylar Cuff Placement Location
- 12 mm proximal to MPT
| - 12 mm posterior to a vertical line bisecting the A/P of the socket
63
Knee Disartic Advantages
- long lever arm and preserved musculature
| - more balanced musculature
64
Quadrilateral Socket: Medial Wall
- pressure on adductors
- contain medial tissues
- line of progression
65
Quadrilateral Socket: Anterior Wall
- surface over which to distribute anterior forces
| - Scarpa's bulge
66
Quadrilateral Socket: Posterior Wall
- height refers to height from floor to ischial level
| - 5-11 degree shape
67
Ischial Containment Principles: STML
Soft Tissue M/L
| - derived from table based on circumferential measurement at 1" level
68
Ischial Containment Principles: Medial Wall Containment
- angled to match ischial-ramus angle
| - prevents medial migration of ischium in socket
69
Ischium Location
Quadrilateral
- on brim
Ischial Containment
- in socket
70
TF Knee Center Alignment
Single Axis Knee
- 1/4" posterior to T-A line
- posterior to the T-A line, depends on type
71
Normal Step Length
Foot reaches 15 degrees behind vertical line originating at the hip.
- 3 degrees pelvic rotation (lordosis)
- 5 degrees hip extension
- 7 knee flexion
72
TF Hip Contracture
Add the amount of contracture to the 5 degrees of socket flexion needed for normal step length
73
Hip Disarticulation
Disarticulation at femoral head/acetabulum
74
HD Advantages
- ischial tuberosity is retained, will tolerate loading well
- balance and comfort for sitting is better than the hemipelvectomy
- ilium is retained - suspension, rotational control, pressure tolerant region
75
Transpelvic Management
```
Amputation at junction of sacrum/ilium
Other Names
- hemipelvectomy
- hindquarter amputation
- transiliac
```
76
Transpelvic Issues "Advantages"
- retains bowel, bladder, and sexual function
- life-saving procedure
- good px rehab among young patients
- pregnancy and successful delivery still possible
77
Transpelvic Issues "Disadvantages"
- weight bearing of IT is lost
- suspension and rotational control are much more difficult to achieve
- energy expenditure 200% of normal ambulation
- usually require crutches and cane for ambulation
- scoliotic changes may result over time
- more prone to postoperative infections
- issues with hygiene due to defecation and urination control
78
Scarpas Triangle
- inguinal ligament superiorly
- adductor longus medially
- sartorius laterally
Dual MSOP Test
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Decks in class (6)
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