Peromelia - congenital transverse deficiency of the upper limb: a literature review and current prosthetic treatment

Patterns of use of a myoelectric prosthesis in a cohort of children with transverse defects below the level of the elbow

BACKGROUND

Myoelectric prostheses have become the accepted standard of care for pediatric upper-limb amputees.

OBJECTIVES

To describe the clinical characteristics and patterns of prosthesis use and to analyze the changes that occur during the growth process of these patients.

STUDY DESIGN

This is a longitudinal retrospective study comparing the results of surveys carried out in 2015 and 2022.

METHODS

The variables measured included clinical and demographic characteristics, patterns of use, and satisfaction with the prosthesis.

RESULTS

Twenty-one patients with transverse defects were fitted with myoelectric prostheses. With increasing age, there was a statistically nonsignificant decrease in the duration of use and a decrease in the number of patients using the prosthesis for activities of daily living from 13 to 10 (p = 0.045), with a 28% dropout rate, higher in patients with more distal defects.

CONCLUSIONS

Since 2015, we have observed a decrease in the number of hours of prosthesis use, while maintaining a high percentage of patients using the prosthesis.

Difference between affected and unaffected sides of forearm bone length in children with congenital terminal transverse deficiencies at the level of carpal bone

The forearm of the affected sideis often shorter than that of the unaffected side in children with congenital terminal transverse deficiencies at the level of proximal or distal carpals. The aim of this study is to clarify the characteristics of forearm bone length in those children, especially to quantify the difference in forearm bone length between affected and unaffected sides. The subjects were children with carpal partial transverse deficiencies. The lengths of the radius and the ulna were measured in the radiographs. The lengths of affected and unaffected sides (A/U) were compared in order to quantify the discrepancy. The A/U ratio was defined as the length of the affected side divided by that of the unaffected side. The A/U ratios ranged from 77.1 to 99.0% in the radii and from 74.1 to 99.6% in the ulnae. In both the radius and ulna, the A/U ratios were significantly lower than the left/right ratios of normal adults. Additionally, the A/U ratios of the ulna were significantly lower than the A/U ratios of the radius. The forearm bones of affected side are significantly shorter than those of unaffected side. Although the cause remains unclear, it is possible that not only congenital factors but also acquired factors such as infrequent use of the affected upper limb are involved. A future longitudinal study is necessary to investigate whether length discrepancies can be reduced by using prostheses to increase the frequency of use on the affected limb.

A rehabilitation protocol for the use of a 3D-printed prosthetic hand in pediatrics: A case report

INTRODUCTION AND PURPOSE

The purpose of this study was to evaluate the outcomes of utilizing a 3D prosthetic device with a home exercise program. This case study was intended to see if the application of a home exercise program utilizing a 3D printed prosthetic hand resulted in increased range of motion, strength, coordination, sensory integration, and perceived function of the upper extremity.

STUDY DESIGN

Case Study METHODS: This study outlines one rehabilitation protocol for a 6-year-old boy with right congenital upper limb deficiency. A 4-week home rehabilitation protocol was utilized with a 3D printed prosthetic hand. Pre-assessment measurements were taken of range of motion, strength testing, BOT-2 coordination, and a sensory questionnaire. The home program included ROM exercises, body-powered use of the 3D printed device, strengthening without the device and sensory integration exercises. The frequency of the protocol was 3 times per week for 30 minutes with adult supervision.

RESULTS

Improvements were seen in range of motion, strength, coordination, and sensory integration. Results demonstrated improved right upper extremity strength with all movements except radial deviation. Range of motion improved with passive and active wrist flexion, extension, and forearm pronation. Sensory integration questionnaires showed decreased sensory sensitivities. A structured home exercise program with and without a 3D printed hand improved upper extremity function in this population.

DISCUSSION

Evaluating the outcomes of a home rehabilitation protocol for a child using a 3D printed hand was successful. The studies evidence will help guide treatment and clinical decision making for future studies.

Prenatal radiographic evaluation of congenital transverse limb deficiencies: A scoping review

BACKGROUND

Congenital transverse deficiencies are horizontal deficiencies of the long bones that occur with a reported incidence as high 0.38%. They can occur alone or represent a manifestation of a various clinical syndromes. Diagnosis has traditionally comprised of conventional radiography and prenatal imaging studies. There has been much advancement regarding prenatal imaging modalities to allow for early diagnosis and appropriate treatment.

AIM

To summarize the current state of knowledge on congenital transverse limb deficiencies and to provide an update regarding the radiographic evaluation of congenital transverse limb deficiencies.

METHODS

This IRB-exempt scoping review followed the PRISMA-ScR checklist for scoping reviews strictly. Five search engines were searched for a total of 265 publications. Four authors reviewed these during the screening process. Of these, 51 studies were included in our article. Prenatal magnetic resonance imaging (MRI), 3D Ultrasound, and multidetector Computed tomography (CT) exist are emerging modalities that have the potential to improve diagnosis.

RESULTS

Use of the appropriate classification system, three-dimensional ultrasonography with a maximum intensity projection, and appropriate use of prenatal MRI and prenatal CT can improve diagnosis and inter-provider communication.

CONCLUSION

Further scholarly efforts are required to develop improve standardized guidelines regarding the pre-natal radiographic evaluation of congenital limb deficiencies.

Novel Use of a Shoulder Spica: Treatment for Midshaft Humerus Fracture in the Presence of Limb Deficiency

Pediatric midshaft humerus fractures are typically managed with a hanging arm cast, Sarmiento bracing, coaptation splint, or a combination of these treatment options. Here we report a novel use of a shoulder spica cast in the treatment of a midshaft humerus fracture in the presence of limb deficiency. Current treatments proved unsuccessful in maintaining adequate alignment, specifically the varus deformity of the fracture. A shoulder spica was able to successfully maintain acceptable alignment throughout the duration of the patient's healing process. This nontraditional use of a shoulder spica cast shows the practicality of its ability to be utilized for the treatment of unique upper extremity orthopedic obstacles.

Relationship between degree of disability, usefulness of assistive devices, and daily use duration: an investigation in children with congenital upper limb deficiencies who use upper limb prostheses

Upper limb prostheses can help children with congenital upper limb deficiencies (ULDs) perform activities of daily living. Although the degree of disability and prosthesis usefulness may be related to becoming accustomed to wearing a prosthesis, these relationships have not been confirmed. This study was aimed at investigating the relationship between motor function, the usefulness of prostheses in everyday activities, and daily duration of prosthesis use in children with congenital ULDs. Eleven children with congenital transcarpal or transradial ULDs and their caregivers participated in this study. The caregivers were asked to complete a questionnaire concerning their children's everyday activities and the daily duration of prosthesis wearing. The adaptive behavior scale was used to measure motor function prior to intervention. Correlations analyses revealed no significant correlation between the children's adaptive behavior, including motor skills before intervention, and daily duration of prosthesis wearing, but revealed a positive correlation between the number of activities that the children performed more effectively with their prostheses and the daily use duration. To ensure that children with congenital ULDs become accustomed to wearing their prostheses, the prostheses should meet the requirements of everyday activities.

Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support

BACKGROUND

Parents of children with congenital limb reduction deficiency have an essential role in making treatment decisions during their child's first years of life. Treatment options usually concern surgical and/or prosthetic treatment. To tailor treatment options to fit different family values and priorities, the family-centred approach indicates the importance of understanding the parental role in partnership with health care professionals. The aim of this study was to describe parents' experiences of their role in decision-making and treatment for children with congenital limb reduction deficiency.

METHODS

A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 17 parents (12 mothers and 5 fathers) of children with upper and/or lower limb deficiency (mean age 5.9 years). The interview data were analysed using qualitative content analysis with an inductive approach.

RESULTS

Two major themes emerged from the data. The first theme, being a decision maker for someone else, was described as an ambivalent parental role, including collaboration within the family and with health care professionals. The second theme, becoming and being a treatment supporter in the child's everyday life, was made up of four categories: being a supporter of the child in everyday activities, mentoring the child to handle encounters with others, becoming a coordinator of information and being an 'extended arm' of the health care provision for the child.

CONCLUSIONS

This study enhances our understanding of the parental role in decision-making and treatment for children with congenital limb reduction deficiency. The results may contribute to the continued development of the family-centred service approach by providing guidelines for treatment programmes, with the goal of improving decision support and broadening the support for parents during treatment for these children.