Introduction The goal of prosthetics are to restore limb function to as close to original function Requires a multidisciplinary team approach for coorindation of efforts to achieve the best outcome Prosthetics upper limb limb salvage is ideal in the upper arm given lack of sensation with prosthetic residual limb length is important for suspending prosthetic socket lower limb goals for prosthetic are comfort, easy to get on and off, light, durable, cosmetic, and functional Gait Antalgic gait describes any gait abnormality resulting from pain shortened stance phase on the affected limb Gait pattern of ambulation with an assistive device 3-point both the crutch and the injured limb move forward together with weight-bearing on the crutches followed by all of the weight on the uninjured limb 4-point first one crutch is advanced, then the opposite leg, then the second crutch, then the second leg, and so on swing-to that in which the crutches are advanced and the legs are swung to the same point swing-through that in which the crutches are advanced and then the legs are swung past them Crutch walking requires more energy than walking with a prosthesis muscles that need strengthening in preparation for crutch walking latissimus dorsi triceps and biceps quads hip extensors hip abductors Wheelchair propulsion 9% increase in energy expenditure compared to ambulation in normal subjects Ambulation assistive devices cane shifts center of gravity towards affected side when cane is used on contralateral side axillary crutch 2 axillary crutches are required for proper gait if lower extremity is non weight-bearing or toe-touch weight-bearing Upper Extremity Prostheses Timing of prosthetic fitting as soon as possible, even before complete wound healing has completed better outcomes if fitted within 30 days Midlength transradial amputation Myoelectric prostheses best candidate is a patient with a midlength transradial amputation transmits electrical activity to surface electrodes on residual limb muscles advantages login to view 2 more bullets disadvantages login to view 2 more bullets Body-powered prostheses indications login to view 1 more bullet techniques login to view 2 more bullets advantages login to view 3 more bullets disadvantages login to view 2 more bullets Elbow disarticulation or above elbow amputation requires a prosthesis to recreate functional motion of two joints (elbow and wrist) this creates heavy and less efficient as the only solution best function with least weight is achieved by combining the various options of myoelectric, body-powered, and body-driven switch components Proximal transhumeral and shoulder disarticulation amputation an amputation this proximal has lost the ability to create a lever arm with mechanical advantage best option is a universal shoulder joint that is positioned in space with the contralateral arm this can be combined with lightweight hybrid prosthetic components Components Terminal device passive terminal device login to view 1 more bullet active terminal device login to view 2 more bullets grips login to view 5 more bullets prehension devices login to view 10 more bullets mechanisms login to view 6 more bullets wrist units quick disconnect wrist login to view 1 more bullet locking wrist unit login to view 1 more bullet wrist flexion unit login to view 2 more bullets elbow units rigid elbow hinge login to view 2 more bullets flexible elbow hinge login to view 2 more bullets shoulder units due to increased energy expenditure and weight of prosthesis many choose to use a purely cosmetic prosthesis indications login to view 1 more bullet Lower Limb Prosthesis Foot prosthesis Single axis foot ankle hinge allows dorsiflexion and plantar flexion disadvantages login to view 1 more bullet SACH (solid ankle cushioned heel) foot indications login to view 2 more bullets disadvantages login to view 1 more bullet Dynamic response (energy-storing) foot indications login to view 2 more bullets articulating and non-articulating dynamic-response foot prostheses are available login to view 16 more bullets Shanks provide structural support between components endoskeleton (soft exterior) or exoskeleton model (hard exterior) can provide a lever arm for propulsion following transmetatarsal amputation Knee prosethesis Indications transfemoral and knee disarticulation amputations patient functional status is an important consideration Six types of prostheses for AKA or through knee polycentric (four-bar linkage) knee login to view 9 more bullets stance-phase control (weight-activated) knee login to view 6 more bullets fluid-control (hydraulic and pneumatic) knee login to view 6 more bullets constant friction (single axis) knee login to view 9 more bullets variable-friction (cadence control) login to view 4 more bullets manual locking knee login to view 3 more bullets Socket the connection between the stump and the prosthesis computer screening technology can decrease time to socket fabrication preparatory socket may need to be adjusted several times as edema resolves patellar tendon-bearing prosthesis is most common for BKA transfemoral or quadrilateral sockets make it hard to keep the femur in adduction transfemoral allow 10 degrees of adduction and 5 degrees of flexion Suspension systems attaches prosthesis to residual limb using belts, wedges, straps, and suction suction suspension standard suction login to view 1 more bullet silicon suction login to view 2 more bullets Pylon simple tube or shell that attaches the socket to the terminal device newer styles allow axial rotation and absorb, store, and release energy exoskeleton soft foam contoured to match other limb with hard outer shell endoskeleton internal metal frame with cosmetic soft covering Osseointegration direct attachment of a prosthesis to the skeleton may improve biomechanical advantage of prosthesis and rehabiliation Terminal device Most commonly a foot, but may take other forms Prosthetic Complications General issues choke syndrome caused by obstructed venous outflow due to a socket that is too snug acute phase login to view 1 more bullet chronic phase login to view 1 more bullet skin problems contact dermatitis login to view 3 more bullets cysts and excess sweating login to view 1 more bullet scar login to view 1 more bullet painful residual limb possible causes include heterotopic ossification, bony prominences, poorly fitting prostheses, neuroma formation, and insufficient soft tissue coverage Transtibial prostheses swing-phase pistoning ineffective suspension system stance-phase pistoning poor socket fit stump volume changes (stump sock may need to be changed) foot alignment abnormalities inset foot (medialized) login to view 1 more bullet outset foot (lateralized) login to view 1 more bullet anterior foot placement login to view 1 more bullet posterior foot placement login to view 2 more bullets dorsiflexed foot login to view 1 more bullet plantar-flexed foot login to view 1 more bullet pain or redness related to pressure prosthetic foot abnormalities heel is too soft login to view 1 more bullet heel is too hard login to view 1 more bullet