Transverse terminal upper limb deficiency through the arm: The problem and management

Background: In 2003, the British Society of Rehabilitation Medicine (BSRM) published guidelines on amputee and prosthetic rehabilitation, including those with congenital limb deficiency.Objectives: The aim of the study was to evaluate the service provided by the Regional Disablement Service (RDS) to children with congenital upper limb deficiency, against BSRM guidelines.Study Design: Retrospective chart review.Methods: Chart review.Results: Analysis of the group ( n = 44) showed 52% were male, with 61% of children affected on the left side, and 73% having a transverse deficiency. Compliance to individual aspects of the guidelines varied considerably. Only 14 (32%) of children had met with the multidisciplinary team by the recommended age of six months. Analysis of referral sources and timings suggested that children were initially seen elsewhere and later referred to RDS after consultation with a surgeon.Conclusions: RDS compliance with the BSRM guidelines was variable. Particularly disappointing was the low rate of children and families meeting the multidisciplinary team at an early age (< 6 months). The low rate of early referral prompted us to contact all paediatricians in Northern Ireland highlighting the guidelines, the benefits of early contact with RDS and encouraging referral on diagnosis.Clinical relevanceThis work will be of interest particularly to those involved in treating paediatric amputees. The challenges we face in treating upper limb deficient children in accordance with current guidance may not be unique and our study may prompt other units to consider how best to improve service to this group.

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Three-dimensional ultrasound in the diagnosis of left upper limb amelia and right upper limb deficiency at 10 weeks' gestation

Ultrasound in Obstetrics and Gynecology ◽

10.1046/j.1469-0705.2002.00779_1.x ◽

2002 ◽

Vol 20 (3) ◽

pp. 303-304 ◽

Cited By ~ 1

Author(s):

P. Megier ◽

O. Esperandieu ◽

J. G. Martin ◽

A. Desroches

Keyword(s):

Upper Limb ◽

Three Dimensional ◽

Limb Deficiency

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First-trimester two-dimensional and three-dimensional ultrasound demonstration of craniofacial defects, abdominal wall defects and upper limb deficiency associated with limb–body wall complex

Taiwanese Journal of Obstetrics and Gynecology ◽

10.1016/j.tjog.2011.10.033 ◽

2011 ◽

Vol 50 (4) ◽

pp. 558-560 ◽

Cited By ~ 3

Author(s):

Chih-Ping Chen ◽

Yi-Yung Chen ◽

Jun-Wei Su ◽

Wayseen Wang

Keyword(s):

Abdominal Wall ◽

Upper Limb ◽

Body Wall ◽

Three Dimensional ◽

First Trimester ◽

Abdominal Wall Defects ◽

Two Dimensional ◽

Craniofacial Defects ◽

Limb Deficiency

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A system of powered prostheses for severe bilateral upper limb deficiency

Journal of Pediatric Surgery ◽

10.1016/0022-3468(66)90121-7 ◽

1966 ◽

Vol 1 (1) ◽

pp. 110

Keyword(s):

Upper Limb ◽

Limb Deficiency

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The care of the limb deficient child in North Africa

Prosthetics and Orthotics International ◽

10.3109/03093649109164653 ◽

1991 ◽

Vol 15 (2) ◽

pp. 152-155 ◽

Cited By ~ 3

Author(s):

N. Sliman ◽

A. Mrabet ◽

S. Daghfous ◽

M. Douik

Keyword(s):

Upper Limb ◽

North Africa ◽

Lower Limb ◽

Deficient Child ◽

Limb Deficiencies ◽

Limb Deficiency

The surgical and prosthetic treatment of longitudinal lower limb deficiency is described and discussed, in the light of cultural and social requirements. Those with upper limb deficiencies are not fitted with prostheses.

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Prescription of the First Prosthesis and Later use in Children with Congenital Unilateral Upper Limb Deficiency: A Systematic Review

Prosthetics and Orthotics International ◽

10.1080/03093640600731710 ◽

2006 ◽

Vol 30 (2) ◽

pp. 165-173 ◽

Cited By ~ 20

Author(s):

M. Meurs ◽

C. G. B. Maathuis ◽

C. Lucas ◽

M. Hadders-Algra ◽

C. K. van der Sluis

Keyword(s):

Upper Limb ◽

Functional Outcomes ◽

Scientific Evidence ◽

Rejection Rate ◽

Cochrane Database ◽

Based Medicine ◽

First Time ◽

Limb Deficiency ◽

Rejection Rates

Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: “prostheses, upper limb, upper extremity, arm and congenital”. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR = 3.6, 95% CI 1.6 – 8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.

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