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A 65-year-old diabetic male with forefoot gangrene is evaluated for possible amputation. When discussing the amputation levels with the patient, which of the following should be noted to require the greatest increase in energy expenditure for ambulation?
Unilateral transtibial amputation
Bilateral transtibial amputations
Through the knee amputation
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What is the most proximal level of amputation that a child can undergo and still maintain a normal walking speed without significantly increasing their energy cost?
Girdlestone hip resection
A 34-year-old male sustains a traumatic injury to his foot following a motorcycle accident. The patient's neurovascular status necessitates the amputation demonstrated in figures A through C. One year following the amputation, the patient complains of difficulty with gait and deformity of the ankle. Which of the following statements best describes the forces resulting in this deformity?
Tight posterior capsule tissues of the ankle
Neuropraxia of the deep peroneal nerve
Unopposed pull of gastrocnemius-soleus only
Unopposed pull of gastrocnemius-soleus, posterior tibialis, and peroneus brevis
Unopposed pull of gastrocnemius-soleus and posterior tibialis
For an above knee amputation, each of the following is a benefit of adductor myodesis EXCEPT:
Allows preservation of greater femoral length
Provides a soft tissue cushion beneath the osseous amputation
Improves the position of the femur to allow more efficient ambulation
Creates dynamic balance of the amputated femur
Improves prosthetic fit
A 66-year-old male sustains an open crush injury to his right lower leg with significant skin loss. His history is significant for COPD, diabetes controlled with an insulin pump, and testicular cancer treated with bleomycin twenty years ago. A radiograph of the chest shows a small pneumothorax which is being observed and does not require a thoracostomy tube. Which of the following is not a contraindication to hyperbaric oxygen treatment for this patient?
Presence of an acute open fracture and crush injury
History of COPD
History of bleomycin treatment
Presence of a pneumothorax
Presence of an insulin pump
A 33-year-old man requires a transfemoral amputation because of a mangling injury to his leg. Six months after the amputation he has persistent difficulty with ambulation because his distal femur moves into a subcutaneous position in his lateral thigh. It persists despite a well-fitted prosthesis. What technical error is the most likely cause of his dysfunction?
Inadequate posterior skin flap
Inadequate anterior skin flap
Failure to bevel the distal femur
Lack of abductor myodesis to femur
Lack of adductor myodesis to femur
Myodesis of which muscle group is most important for optimal outcome after transfemoral amputation?
Hip external rotators
In addition to lengthening the Achilles, transfer of which tendon is most important for functional ambulation after performing a Chopart amputation of the foot?
Flexor hallucis longus
A 7-year-old male is struck by a motor vehicle while crossing the street and suffers an open tibia fracture with a crush injury of the ipsilateral foot. After multiple attempts at limb salvage, the family and treating surgeon elect to proceed with a knee disarticulation. What complication of pediatric amputations is avoided with a knee disarticulation as opposed to a transtibial amputation?
Hip flexion contracture
Hip adduction contracture
Leg length inequality
Figure A shows a below the knee amputation performed in a diabetic patient with significant vascular disease. Removal of the "dog ears", indicated by the red arrows, could cause direct damage to what vasculature leading to flap necrosis?
Anterior tibial artery
Saphenous and sural arteries
Posterior tibial artery
Lower popliteal artery
Which of the following is most important to achieve a good outcome following a Syme amputation?
trimming any dog ears
a viable and stable heel pad
achilles tendon lengthening
preserving the malleoli
tenodesing the extensor digitorum longus to the tibial shaft
Which of the following amputations will lead to the greatest oxygen requirement per meter walked following prosthesis fitting?
During a Lisfranc (tarsometatarsal) amputation of the foot, which of the following is crucial to prevent the patient from having a supinated foot during gait.
Releasing the posterior tibialis tendon
Preserving the soft-tissue envelope (peroneus brevis, tertius and plantar fascia) around the fifth metatarsal base
Myodesis of the anterior tibialis to the medial and middle cuneiforms
Lengthening of the gastrocsoleus (achilles tendon)
Osteotomy through 1st metatarsal
A 70-year-old female with a history of poorly controlled diabetes mellitus presents with purulent ulcers along the plantar aspect of her right forefoot and exposed metatarsal bone. She elects to undergo an amputation. She is insensate to the midfoot bilaterally. Her ankle-brachial index (ABI) for her right posterior tibial artery is 0.4. Further preoperative evaluation demonstrates a transcutaneous oxygen pressure of 45 and an albumin of 3.4. Which of the following would be a contraindication to performing a Syme amputation (ankle disarticulation) in this patient?
Albumin of 3.4
ABI of 0.4 for the posterior tibial artery
Transcutaneous oxygen pressure of 45
Which of the following is true of a knee disarticulation as compared to a transtibial amputation?
Faster self-selected walking speeds
Improved performance on the Sickness Impact Profile (SIP) questionnaire
Physicians were more satisfied with the cosmetic appearance
Decreased use of a prosthetic
Decreased dependence with patient transfers
A through-knee disarticulation has been shown to have what advantage over a traditional above-knee (transfemoral) amputation?
Decreased rate of prosthesis adjustment
Less postoperative time to final prosthesis fitting
Decreased neuroma formation
Decreased rate of revision
Less energy expenditure with ambulation
A 40-year-old male who sustained an open pilon fracture 2 weeks ago is scheduled for a below-the-knee amputation (BKA). What laboratory value is the best predictor for wound healing?
serum albumin level
total protein level
A 45-year-old diabetic woman with a gangrenous foot undegoes a Chopart amputation without tendon transfer or lengthening. Which type of deformity is the most likely complication of this procedure?
A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable. He undergoes transfemoral amputation. Three months later the patient presents to the office with the limb sitting in an abducted position. What important step was forgotten during the amputation?
Beveling the distal femur
Saving the patella
Allowing the sciatic nerve to retract deep into the soft tissue
Myodesis of the adductors
Timely fitting of orthosis
A 37-year-old man presents to the emergency room with the left lower extremity injury shown in Figure A. A radiograph is shown in Figure B. Which of the following has the most impact on the decision to attempt limb salvage versus amputation?
Quality of initial fracture reduction
History of tobacco use
Extent of soft tissue injury
Operative debridement and irrigation within 1 hour of injury
the video shows how to plan a prosthesis for hip disarticulation. In addition, i...
HPI - Machete wound to heel, 2 day referral to teaching hospital with calcanectomy.
HPI - 48-year-old male s/p ORIF calcaneus and subsequent flap coverage approximately 3 years ago at outside hospital. Infection developed and he underwent a Burgess-type transtibial amputation at the same facility.
He has continued pain in his limb which limits his activity. He notes instability between his tibia and fibula when he wears his prosthetic (chopsticking). Of note, he is employed by a prosthetist as a tester of new equipment and prosthetics.
What would you do for this patient?
HPI - Run over by a 4 wheeler on 27.12.15. Isolated injury to left leg. Clinical and xrays attached to show the extent of the wound.
How would you treat this acutely following the initial debridement and exploration?