Traumatic Amputations (1).orthopaedic carepptx

orthopaedic care

1. Traumatic Amputations

2. Introduction Traumatic amputations are, Injuries to a limb or part of the limb that results in immediate separation or the severity of injury results in complete loss of the limb Ie : crush injuries, mangled limbs, irreparable loss of vascular supply to the limb Major Limb Amputations Arms, Legs Digit amputations / Finger tip amputations

3. Incidence Majority of amputations Non traumatic Infection (DFU PVD Malignancy Only 10-15% direct result from trauma Incisional crushed

4. Causes Industrial injuries Firecrackers MVA

5. Major Limb - Crushed/Mangled

6. How do we know if its salvageable?

7. MESS

8. Sequence of replantation Bone Blood Vessels (artery, Vein) Tendons Nerves

9. Digit amputations Treatment Replantations

10. Finger Tip Treatment - Flaps

11. Pre-op Management Pt stabilization and amputated part management for salvage

12. How to care for amputated part Ice bath Wash Wrap Bag Bath

13. Patient Management Early Management – Preservation of Life Arrest bleeding Tourniquet Clamp bleeding artery Manage Shock Hypothermia/ Acidemia /Coagulopathy Large Bore branula IV fluids/Blood products Prevention of Infection Open fracture management IV abx Irrigation and dressing Early debridement

14. Immediate Post Op Wound Healing albumin > 3.0 g/dL transcutaneous oxygen tension > 30 mm Hg (ideally 45 mm Hg) ankle-brachial index (ABI) > 0.45 total lymphocyte count (TLC) > 1500/mm3 Hb > 10

15. Rehabilitation

16. Post Op

17. Metabolic Demands Syme - 15% transtibial short BKA - 40% long BKA - 10% transfemoral AKA traumatic - 68%

18. Goals the goals of amputation are preserve functional length preservation of useful sensibility prevention of symptomatic neuromas prevention of adjacent joint contractures early prosthetic fitting early return of patient to work and recreation

19. Thank You