Personal Injury Amputations
Further Information
Diagnosis of traumatic amputation can be made relatively easily when a limb or appendage is completely severed; however, when partial amputation occurs, it must be determined how much of the affected appendage can be salvaged. This is crucial as salvaging a limb or appendage can mean the difference in how much function the person will have in the future.
If a limb is to be removed surgically, diagnosis then focuses on determining the proper level of amputation, with the goal of preserving as much of the limb as is possible. The task becomes finding the level of amputation where healing will be most likely to be complete.
Ideally, anyone who has a partial or complete traumatic amputation of a limb will be cared for at a hospital where personnel and equipment to care for this type of injury.
Several tests may be done to assess the level and quality of blood flow through a limb. These tests may be used to assist a physician is determining how much of a limb may be salvaged. Some of these tests may only be available in larger centres or trauma facilities:
- Blood Pressure-Blood pressure can be measured in several areas of the limb to assess blood flow.
- Xenon 133- This test involve the use of radioactive material to study blood flow.
- Oxygen Tension- An oxygen probe placed under the skin helps determine where healing has the best chance to occur, based on measures of oxygen pressures.
- Skin Fluorescent Studies- These tests measure and assess the circulation of the skin.
- Skin Temperature Studies- Using infrared technology, it can be determined where the areas of greatest blood flow are.
In traumatic amputation, the level of amputation is determined by the level of injury, or which parts of the body were affected by the injury. Surgeons adhere to the maxim that preservation of limb length and joint function is of utmost importance in order for the individual to fit and use prosthesis. The energy required to use a limb increases as the limb becomes shorter.
Upper Limb Amputations
- Amputation of individual digits- the thumb is the most commonly amputated digit, and loss of this digit will impair the ability to grasp objects. When other digits are lost, grasping ability is affected but they will retain some grasping ability.
- Multiple digit amputation- when more than one digit is lost, surgeons may be able to construct muscles to aid grasping ability.
- Metacarpal amputation- this type of amputation involves loss of the entire hand but the wrist is still intact; there will be no ability to grasp.
- Wrist disarticulation- involves the loss of the hand, but at the level of the wrist joint. Technology now exists to have plastic sockets made to serve as wrists.
- Forearm (transradial) amputation- this type of amputation may be classified by the length of the remaining stump. As stump length decreases, so does the pronation ability, or the ability to rotate the forearm.
- Elbow disarticulation- this type of amputation involves the removal of the entire forearm at the elbow. In this type of amputation, the person will retain the ability to hold weight.
- Above-elbow (transhumeral) amputation- involves amputation anywhere above the elbow and below the shoulder. If some length is left to the humerus, a prosthesis may still be used.
- Shoulder disarticulation- in this type of amputation, the shoulder blade remains. The collarbone may or may not be removed.
- Forequarter amputation- includes removal of the shoulder blade and collarbone. Surgeons would ideally leave some length of bone for prosthetic use.
Lower Limb Amputations
- Foot amputations- can include any portions of the foot, such as toes and mid-tarsal amputations. The big toe is commonly affected, and may affect balance and walking.
- Ankle disarticulation (Syme amputation) - involves amputation of the entire ankle. In this type of amputation, the victim can mobilize without prosthesis.
- Below-knee (transtibial) amputation- amputation occurs above the ankle but below the knee. Victims retain the use of the knee, but may have difficulty putting weight on the stump.
- Knee-bearing amputation- amputation involves the complete removal of the lower leg. It may be difficult to create a prosthesis in this type of injury.
- Above-knee (transfemoral) amputation- involves amputation at the level of the thigh. The individual will be able to sit with this type of amputation.
- Hip disarticulation- involves removing the entire leg bone. Surgeons will try to preserve some length in the femur to allow the use of a prosthesis.
The overriding goal of the surgeons is to leave enough bone and preserve the joint where possible to allow the victim to be able to use a prosthesis.
Rehabilitation
Amputation Rehabilitation is crucial to assist the patient in regaining as much function as possible. Ideally, rehabilitation should begin before amputation surgery. Physiotherapists can show the patient the exercises that will be needed after surgery to begin rehabilitation. Additionally, a prosthetist (someone who makes prosthetics) may see the patient to discuss use of a prosthetic device after surgery (amputation). This may not be possible if the amputation is done on an emergency basis.
Upper Limb Amputation Rehabilitation
In upper limb amputation, the hand or one or more of the fingers may be removed. The arm may be removed below the elbow or above it, or at the shoulder.
Most patients with an amputation of an upper limb will be fitted for an artificial arm, which can include fingers, a hook or hand, a wrist unit, and an elbow unit if the patient’s amputation is above the elbow. Movement of the hook or hand is accomplished mainly by movement of the shoulder muscles. Control of above-elbow prosthesis is generally more complicated than below-elbow prosthesis. Newer prosthetic devices can use energy produced by the patient’s own muscles to produce movement (myoelectric prosthetic devices).
Rehabilitation for an upper limb amputation involves:
- General conditioning exercises
- Exercises to strengthen existing arm muscles
- Relearning activities of daily living with and without a prosthesis
Lower Limb Amputation Rehabilitation
In lower limb amputation, the leg may be removed above or below the knee, or at the level of the hip. Alternately, a foot or one or several toes may be removed.
Most patients who lose a lower limb are fitted for a prosthetic device, or an artificial leg.
Rehabilitation involves:
- Exercises to stretch the hip and knee (for amputations below the knee)
- General exercises to strengthen existing arm and leg muscles
- Standing and balancing exercises, which are usually done with parallel bars
- Endurance exercises
- Teaching the patient how to avoid contractures, or muscle shortening, which can occur after prolonged bed rest or sitting in a wheelchair.
Rehabilitation involves a lot of patient teaching. Amputation patients must learn how to condition the stump. This is done to prepare the stump for prosthesis, and usually involves the use of stump shrinkers or elastic bandages which are worn day and night. The purpose of this is to provide shape to the stump and to prevent swelling of the stump and fluid retention.
The patient may be provided with a temporary prosthesis so that learning to walk can begin. The patient progresses from using a walker or crutches to using a cane fairly quickly, and may
be able to walk on their own in a matter of weeks.
When the patient is ready to use their permanent prosthesis, they must be taught how to put it on and take it off, how to care for the device and the stump, and how to walk in it.
Rehabilitation is generally long-term for a lower limb amputation. Patients must not only learn how to walk; they must learn skills such as walking on uneven surfaces and up and down stairs. Walking with a prosthetic device requires much more energy, and how quickly a patient progresses through rehabilitation depends on their age and physical condition before the amputation.
Equipment
The most common and important piece of equipment to a person with an amputation is their prosthetic device. An artificial limb should be comfortable, functional, and allow the individual to be more mobile and independent. A physical therapist is needed to train the patient for use of the prosthetic device, making sure they get the most out of it. The type of prosthetic assigned to an amputee will largely depend on your functional and lifestyle needs.
Following amputation, many patients will have a continuing need for some form of medical equipment, such as:
- Prosthetic devices
- Stump socks and sleeves
- Skin care products for caring for the stump (i.e. lotions, antiperspirants, and powders)
- Canes
- Crutches
- PiPal
- Walkers
- Wheelchairs
- Bathroom fixtures (i.e. safety bars, shower chairs)
- Cushions for wheelchairs
Driving
Many patients will wonder about driving after an amputation. Vehicles can be modified to allow amputees to drive. Modifications may include the use of hand controls or modification of the accelerator and brake system.
Patients may turn to support groups for qualified advice on the use of equipment and equipment required after an amputation, or they may ask their physician or rehabilitation therapist
If you or someone you know have suffered an amputation due to a personal injury accident please don’t hesitate to call one of our advisors for more information. Alternatively contact us on the form below providing some details of your case.
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