جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/ افضل استشاري عظام في الاردن / عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور / خلع الولادة / تركيب المفاصل الاصطناعيه للركبه والورك / اوجاع العظام / افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور / مستشار جراحة عظام الأطفال. بتر الاطراف

1. 11/7/2014 Professor Freih Abuhassan -
University of Jordan
1

2. A procedure that removes a
part of a limb through one
or more bones .
11/7/2014 Professor Freih Abuhassan - 2
University of Jordan

3. A procedure that removes
a part through a joint.
The term amputation is
applied to both procedures
11/7/2014 Professor Freih Abuhassan - 3
University of Jordan

4. Is the most ancient of all
surgical procedures
11/7/2014 Professor Freih Abuhassan - 4
University of Jordan

5. Treatment Punishment Cosmetic
Wounds Stealing Sacrifice
Fractures Laziness Mimic amputee gods
Deformity Rebellion
Infection
Gangrene
Ergotism
Pain
11/7/2014 Professor Freih Abuhassan - 5
University of Jordan

6. World War I Amputation
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University of Jordan

7. 1- The limb was rapidly severed
from an un-anesthetized patient.
2-The open stump was crushed or
was dipped in boiling oil, for
hemostasis .
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University of Jordan

8. 11/7/2014 Professor Freih Abuhassan - 8
University of Jordan

9. 11/7/2014 Professor Freih Abuhassan - 9
University of Jordan

10. 11/7/2014 Professor Freih Abuhassan - 10
University of Jordan

11. Amputation surgery
and prosthetics were
much improved by
Ambroise Paré,
a French military surgeon.
11/7/2014 Professor Freih Abuhassan - 11
University of Jordan

12. 1- Created more functional stumps.
2- The first to use ligatures to
control bleeding after amputation
3-He designed relatively
sophisticated prostheses.
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University of Jordan

13. 11/7/2014 Professor Freih Abuhassan - 13
University of Jordan

14. Amputation surgery was
further improved by
Morel’s introduction
of the Tourniquet
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University of Jordan

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University of Jordan

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University of Jordan

17. With the development of anesthesia
and aseptic technique
Surgeons for the first time
1-Could carefully fashion sturdy and
functional amputation stumps
2-Could reasonably anticipate healing
of the wound without infection
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University of Jordan

18. War Anesthesia
•Chloroform
•Ether
•Opium
•Whiskey
•Quinine
11/7/2014 Professor Freih Abuhassan - 18
University of Jordan

19. War Surgical Tools.
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University of Jordan

20. USA
Prevalences from 350,000 to
over 1 million amputees .
20,000 - 30,000 new
amputees each year.
11/7/2014 Professor Freih Abuhassan - 20
University of Jordan

21. * 85-90 % in L.L
- 50% are below knee
- 40% above knee
- 10% are hip Disarticulations
* R=L
* 75% in men
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University of Jordan

22. Amputee Incidence
• Approximately 310,000 in USA
– 2/3 are missing a lower limb
(1996)
– 7% are below 21 years of age
•>% missing upper limb
•Twice as often due to
congenital
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University of Jordan

23. Irreparable loss of the blood
supply of a diseased or injured
limb is the only absolute
indication for amputation
regardless of all other
circumstances.
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University of Jordan

24. 1-Ablation of diseased tissue
2-Reconstruction:
3-Optimize pt function and
reduce morbidity to produce
a physiological end organ.
4 -Reduce mortality
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University of Jordan

25. 1-P V. DISEASE 78%
2-INJURY  20%
3-INFECTION
4-TUMORS  5%
5-NERVE INJURIES
6-CONG. ANOMALIES  3%
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University of Jordan

26. =In elderly people
D.M & vascular diseases are more
common in this age group.
=Gangrene of a limb caused by
arteriosclerosis
more difficult to treat in the presence of
D.M because the tissues heal poorly and
are more susceptible to infection in
diabetic patients
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University of Jordan

27. =Diabetic Neuropathy.
Even when sub clinical, can cause
delayed healing when diminished
sensation results in repeated but
unnoticed injuries
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University of Jordan

28. The 2nd most common indication for amput.
1= Crush injury: when the
blood supply of a limb is
irreparably destroyed or when
the limb is so severely damaged
that reasonable reconstruction
is impossible
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University of Jordan

29. 2= Thermal burns or frostbite
may destroy enough tissue to make
amputation necessary
3= Severe electrical burns
often require amputation
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University of Jordan

30. Infection, either acute or chronic, that
is unresponsive to medical or other
surgical measures may be an indication
for amputation.
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University of Jordan

31. 1-fulminating gas gangrene
Most dangerous and usually demands
immediate amputation at a proximal
level through normal viable tissues
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University of Jordan

32. 2-Chronic Osteomyelitis or an
infected un-united fracture
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University of Jordan

33. 3- Carcinoma
develops in a chronic draining sinus
4- T.B lesions of the foot & ankle
when secondarily infected.
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University of Jordan

34. = Malignant tumors
(to remove the malignancy before
it metastasizes )
= Amputation after metastases
(to relieve pain when a neoplasm has become
ulcerated and infected or has caused
a pathological fracture)
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University of Jordan

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University of Jordan

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University of Jordan

37. =Trophic ulcers in an anesthetic limb.
=Functionless limb.
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University of Jordan

38. 1- Fibular hemimelia &
tibial hemimelia.
2- PFFD.
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University of Jordan

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University of Jordan

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University of Jordan

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University of Jordan

42. 1.Clinical
Pulses, Skin temp., level of
dependent rubor
2- Doppler
Ankle/ Brachial index
3-Toe systolic BP
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University of Jordan

43. 4-Transcutaneous PO2
for assured healing
5-Arteriogram
6-Others:
Skin blood flow (Xe 133 clearance)
Thermography
Thallium scanning
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University of Jordan

44. Serum albumin at least 3g/dl
WCC more than 1500/ mL
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University of Jordan

45. = Control D.M
= Evaluate
= Preop TPN in malnourished pt
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University of Jordan

46. = Early plan for return to function
= Preop Counselling
= Amputee support groups
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University of Jordan

47. Pain Clinic review
Spinal anaesthesia
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University of Jordan

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University of Jordan