Prosthetics –

Early Management
Dr. Tooba Asif, PT
Lecturer
DPT (RIU), MS-OMPT (RIU)
Certification in Musculoskeletal Therapy
Certified Kinesio Taping Practitioner (CKTP)
 Prosthetics

• Prosthetics is the evaluation, fabrication, and custom

fitting of artificial limbs to the amputees
 Prosthesis

• A prosthesis is a device designed

to replace, as much as possible,
the function or appearance of a
missing limb or body part. An
orthosis, in contrast, is a device
designed to support, supplement,
or augment the function of an
existing limb or body part.
 Clinical team approach
to Rehabilitation

• The rehabilitation team concept gained popularity after

World War II with the need to care for a large number of
injured soldier, particularly those with amputations.
• Because contemporary medical care is often fragmented
with insufficient communication among clinicians, it is
especially worthwhile to describe a model of excellent
care in which all parties work co-operatively.
 Rehabilitation team for
Lower-Limb amputee

• The adult who is about to undergo elective Lower-limb

amputation or who has sustained a traumatic limb loss will
interact with the core prosthetic clinic team composed of:
– Orthopaedic surgeon
– Physician
– Prosthetist
– Physical therapist
 Rehabilitation team for
Upper-Limb amputee

• If a patient faces upper-limb amputation whether elective

or traumatic the rehabilitation constitutes:
– Orthopaedic surgeon
– Physician
– Prosthetist
– Physical therapist
– Occupational therapist
 Rehabilitation team
for a Child amputee

• Rehabilitation team for child with an amputation consists

of:
– Esp. Paediatrician as a central participant
– Orthopaedic surgeon
– Physician
– Prosthetist
– Physical therapist
 General members
of a rehabilitation team

• Physician
• Surgeon
• Prosthetist
• Orthtotist
• Pedorthist
• Physical therapist
• Occupational therapist
• Nurse
• Social Worker
• Psychologist
• Rehabilitation counsellor
 Rehabilitation physician/
Physiatrist

• A rehabilitation physician is also known as a physiatrist.

Rehabilitation physicians are medical doctors who work to
develop function in people with disabilities, and to help
those who have suffered from debilitating injuries or
illnesses to regain function. Rehabilitation physicians work
with people who have suffered from strokes, spinal cord
injuries, traumatic brain injuries, and sports related
injuries.
 Orthopaedic Surgeon

• An orthopedic surgeon, or orthopaedic surgeon, is a

surgeon who has been educated and trained in the
diagnosis and preoperative, operative, and
postoperative treatment of diseases and injuries of
the musculoskeletal system.
 Prosthetist

• A Prosthetist is a person who measures, designs,

fabricates, fits, or services a prosthesis as prescribed
by a licensed physician, and who assists in the
formulation of the prosthesis prescription for the
replacement of external parts of the human body lost
due to amputation or congenital deformities or
absences.
 Orthotist

• The Orthotist's role is to assess, prescribe, apply and

provide education regarding the use and care of an
appropriate orthosis that serves the individual's
requirements.
 Pedorthist

• Pedorthist is the title of a health care professional who

specializes in the use of footwear and supportive devices
to address conditions which affect the feet and lower
limbs. They are trained in the assessment of lower limb
anatomy and biomechanics, and the appropriate use of
corrective footwear – including shoes, shoe
modifications, foot orthoses and other pedorthic devises
 Physical therapist

• Physical Therapists (PTs) provide services that help

restore function, improve mobility, relieve pain, and
prevent or limit permanent physical disabilities of
patients with injuries or disease
 Occupational therapist

• An occupational therapist (OT) is trained in the practice of

occupational therapy. The role of an occupational therapist is
to work with a client to help them achieve a fulfilled and
satisfied state in life through the use of "purposeful activity or
interventions designed to achieve functional outcomes which
promote health, prevent injury or disability and which
develop, improve, sustain or restore the highest possible level
of independence.
 Social Worker

• Provide social services to the amputees depending

upon the requirement and availability
 Psychologist

• A psychologist evaluates, diagnoses, treats, and

studies behavior and mental processes
• In rehabilitation, the psychologists prepare and
counsel the amputee to get prosthesis and get back
in life near to normal
 Amputation Surgery:
Osteomyoplastic
Reconstructive Technique

• Amputation Osteomyoplastic, or bone bridging, is a

technique developed to better correct the residual limb to a
normal physiological status.
• Proponents of this technique report that the bone bridging
between the tibia and fibula prevents the fibular instability
that occurs secondary to loss of the ankle mortise and
creates a larger and more stable end-bearing construct.
 Amputation Surgery:
Osteomyoplastic
Reconstructive Technique

• The Osteomyoplastic lower extremity amputation

procedure was described by Professor Janos v. Ertl,
MD, in 1939.
 Advantages Osteomyoplastic
transtibial amputation

• The advantages of this technique are:

• A wide stable surface, perhaps comparable to a Syme's amputation stump,
providing excellent conditions for end bearing.
• Even in very short stumps the bony fixation to the tibia stabilizes the fibula against
the lateral force of the strong biceps femoris.
• Occlusion of the medullary cavities, thus restoring normal intramedullary pressure
and normal deep venous return.
• Protection of the cut ends of nerves and vessels by a bony wall.
• Excellent conditions for soft tissue coverage.
• Increased thickness 1,4 of the fibula.
 Postoperative Management

• Management during the postoperative period is

crucial to the patients' future functional abilities.
• Physical & psychological issues not addressed during
this critical time can hinder a person’s recovery and
quality of life.
 Postoperative care

• All postoperative protocols have similar goals to:

– Heal the surgical wound
– Minimize pain
– Protect the amputated limb from trauma
– Preserve and improve the range of motion and strength of the entire body
– Reduce swelling and begin shaping the amputated limb
– Enable the patient to learn to use appropriate mobility aids
– Begin controlled weight bearing
– Accomplish functonal activities
– Fascilitate psychological adjustment to limb loss
 Stump Management

• Shape residual limb so it is tapered at the distal end to allow for prosthetic fit
• Figure 8 ace bandage wrap
– wrapped distal to proximal
– more pressure distally
– never wrap circular direction because of tourniquet effect
– pt wears wrap continually
– check skin 3-4 times each day
• Elastic shrinker or sock
– less effective than ace bandage
 Removable rigid dressing

• Removable rigid dressing

plaster or fiberglass
replace as residual limb shrinks