Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

A

B

D E FIGURE 30-38.  A child with bilateral amelia or bilateral phocomelia, when the hands cannot meet in the midline, will use the feet for most activities. In such children, the use of the feet should be encouraged and developed from an early age (A) . When older, these children will need the use of their feet to accomplish the activities of daily living (B,C) . If there is any motor power in the extremities, they may be capable of useful function and assist the feet (D) . When the hands can meet in the midline and have good motor power, excellent function is possible (E) .

C

Functionally, these children have a more favorable natural history than one might initially surmise. Quality of life and functional outcomes in these patients demonstrate good func- tion as compared to normal peers (195). Nevertheless, children with this deficiency present the most ideal upper extremity deficiencies for prosthetic fitting. Children with this deficiency are unlike those with a transverse amputation through the car- pal bones, which usually have partial grasping function with sensation. They are also unlike the above-elbow deficiencies in that they have a normal shoulder and elbow that allow accurate placement of a relatively light prosthetic terminal device.

Despite being ideal candidates for prosthetic use, not all chil- dren with congenital transverse forearm deficiency will remain good prosthetic users during their childhood. Scotland andGalway reviewed the experience at the Ontario Crippled Children’s Center and found that 32% had stopped using their prosthesis, upon fol- low-up of 7 to 17 years (198). Howmany of these may resume use of the prosthesis while employed is unknown. They, like Brooks and Shaperman (199), noted greater acceptance of the prosthesis if fitting was done before the age of 2 years. In the congenital group of Brooks and Shaperman (199), 22% of those fitted before 2 years of age, and 58% of those