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888 AClJrE CARE HANDBOOK FOR PHYSICAL TIIERAPISTS

world.' The various locations of LE amputation are shown m Figure

V11-1 and are described in Table VlI-l.

Upper-Extremity Amputation

UE amputation is most often the result of trauma, such as automobile or

industrial accidents.' Disease and congenital limb deficiency are also

major causes of UE amputation.2 Despite peripheral vascular disease

being a major cause of LE amputation, it often does nOt create the need

for UE amputation.' The various locations of UE amputations arc shown

in Figure V11-1 and are described in Table vn-2.

Physical Therapy Intervention for Patients

with an Amputation

The focus of physical therapy intervention in the acute care setting is on

preprosthetic evaluation and training. Prosthetic training, if appropriate,

most often occurs in the subacute or horne setting. The primary components of the evaluation for a patient who is status post amputation in the acute care setting are the following':

•

The onset and type of amputation

•

Premorbid lifestyle and functional mobility

•

Currem level of functional mobility

•

Discharge plans

Table V1I-3 outlines general physical therapy considerations and treatment suggestions for the care of patients who experience UE or LE amputations. Table V1I-4 outlines specific clinical concerns for these patients.

APPENDIX VII: AMPlJfATION

889

Shoulder

disartlculatJon'----

Above-elbow

amputation

8ekJw-elbow

amputation

A

Figure VII-t. Levels of amputation, A. Upper extremity. (Reprinted with permission from AB Maher. SW Salmo,Jd, TA Pel/ino /eds), Orthopaedic Nursillg (211d edt. Philadelphia, Sal/llders, 1998;724.)

890 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Hemipelvectomy

Hip

disarticulation -- -............ _ ..

Above-knee

(translemoral)

amputation

Knee

Below-knee

(transtibial)

amputation

Syme's

Transmetatarsal ____

amputation

Toe

Ray

amputation

B

Figure Vll-l_ Co"tinued. B. LOlller extremity.

APPENDIX VII: AMPlITATION

891

Table VII-I. Types of Lower-Extremity Amputations"

Type

Description

Ray

Single or multiple rays can he amputated depending on

the patient's diagnosis. If the first ray is amputated, halance is often affected, as weight is transferred to the

lateral border of the foot, which may also cause ulceration and skin break down. Postoperative weigln-bearing statuS will range from non-weight bearing to partial weight bearing according to the physician's

orders.

T ransmeratars.11

The metararsal bones are transected with this procedure

as compared to other types of partial foot amputations,

which may disarticulate the metatarsals from the

cuboid and cuneiform bones. Balance is maintained

with a transmetatarsal amputation, because the

residual limb is symmetric in shape and major muscles

remain inract. An adaptive shoe with a rocker-bottom

is used [Q help facilitate push-off in gaiL

S)'me's

Often performed with traumatic and infectious cases, this

amputacion

type of amputation is preferred to more distal, partial

(ankle

foor amputations (Ray and transmetatarsal) because of

disarticulation)

the ease of prosthetic management at this level.

Patients may ambulate with or without a prosthesis.

Below the knee

Ideal site for ampumtion for patienrs with a variery of

(rransribial)

diagnoses. Increased success rate with prosthetic use. In

cases with v3scular compromise, the residual limb may

be slow to heal. Residual limb length ranges from 12.5

cm to 17.5 cm from the knee joinr.

Through-the-knee

Often performed on elderly and young patienrs. M,axi

(disarticulation)

mum prosthetic control can be achieved with this procedure because of the ability [Q fully hear weight on the

residual limb. Also, a long muscular lever arm and

intact hip musculature contribute to great prosthetic

mobility. The intact femoral condyles, however, leave a

cosmetically poor residual limb.

Above the knee

Traditional transfemoral amputation preserves 50--66%

(trans femoral)

of femoral length. Prosthetic amhulation with an

artificial knee joint requires increased metabolic

demand.

Hip

Often performed in cases of trauma or malignancy. The

disarticulation

pelvis remains intact; however, patients may experience

(femoral head

slow wound heeling and may require secondary

from

grafring to fully close the amputation site.

acetabulum)

892 ACUTE CARE HANDBOOK FOR I'HYSICAL THERAPISTS