Amputations: Overview

For the amputee, it is important to determine:

1. Maximum medical improvement and functional outcomes

2. Costs of prosthetic devices and replacement schedule

3. Types of rehabilitation, frequency, and costs

4. Adaptive equipment and costs

5. Architectural modifications to maximize function

6. Level and amount of attendant care

7. Work restrictions

8. Psychosocial and vocational/avocational needs

9. Future medical and surgical needs
   

Phases of amputation rehabilitation can be broken down into:

1. Outpatient: pre-operative

2. Inpatient: surgical and acute postsurgical

3. Outpatient: pre-prosthetic, prosthetic fabrication and training, community reentry which can include vocational/avocational, and follow-up
   

Amputation of the upper extremity can be divided into:

1. Interscapular-thoracic: most severe level, entire arm/scapula/clavicle removed

2. Shoulder disarticulation: arm is removed at the shoulder, including the glenohumeral joint, scapula and clavicle remain

3. Above elbow: any level below the glenohumeral joint (a) Short above elbow: functionally, same as disarticulation. (b) Long above elbow: most functional, leaves stump to contain artificial limb socket

4. Elbow disarticulation: removes arm through the elbow joint

5. Below elbow: passes through both radius and ulna bones

6. Wrist disarticulation: leaves an irregularly shaped distal forearm

7. Partial hand

Amputations of the lower extremity can be divided into:

1. Hemipelvectomy: most severe level, removes limb through half of the pelvis; ischial tuberosity is absent

2. Hip disarticulation: preserves the ischial tuberosity and pelvis

3. Above knee: if stump is long enough, the patient has good hip control

4. Knee disarticulation: sometimes involves removal of the patella

5. Below knee: preserves the patella and leave functioning knee joint

6. Syme: section through the ankle, with sharp ends of tibia and fibula removed

7. Transmetatarsal/partial foot: usually managed without a prosthesis

Amputation complications include:

1. Stump edema

2. Ulceration

3. Contractures

4. Infections

5. Pain: usually due to neuroma, phantom pain

6. Bone overgrowth

7. Psychological