Prosthetic management of children with unilateral congenital below-elbow deficiency
Jon R Davids1, Lisa V Wagner, Leslie C Meyer
1Motion Analysis Laboratory, Shriners Hospital for Children, 950 West Faris Road, Greenville, SC 29601, USA. jdavids@shrinenet.org
Insights
Optimal prosthetic fitting for children with below-elbow deficiency involves early intervention before age three and tailored training. Utilizing diverse prosthetic designs throughout growth enhances outcomes for congenital limb differences.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Controversy exists regarding optimal prosthetic management for children with unilateral congenital below-elbow deficiency.
- Key areas of debate include fitting age, prosthetic training intensity, and design preferences.
Purpose of the Study:
- To analyze outcomes of prosthetic management in children with unilateral congenital below-elbow deficiency.
- To identify factors influencing successful prosthetic use and long-term outcomes.
Main Methods:
- Retrospective analysis of 260 children treated between 1954 and 2004.
- Outcomes assessed by clinic attendance and self-reported prosthetic use.
- Survival analysis used to evaluate prosthetic success.
Main Results:
- 49% of children had an unsuccessful prosthetic outcome.
- Fitting before age three significantly improved outcomes (p < 0.001).
- Intensive training with active terminal devices and varied prosthetic designs enhanced success.
Conclusions:
- Initial prosthetic fitting before age three is recommended for children with unilateral congenital below-elbow deficiency.
- Intensive occupational therapist-directed training and diverse prosthetic designs are beneficial.
- Further research requires refined outcome definitions and validated instruments.
Background:
There is substantial controversy concerning the prosthetic management of children with unilateral congenital below-elbow deficiency. The optimal age at the time of the initial fitting, the value of intensive prosthetic training, and the preferred prosthetic design for these children have not been established.
Methods:
The outcomes of prosthetic management for 260 children with unilateral congenital below-elbow deficiency, treated between 1954 and 2004, were analyzed with respect to ongoing clinic attendance and self-reported prosthetic use. A successful prosthetic outcome was defined as a child and parents who continued to attend the limb-deficiency clinic and claimed at the time of the most recent follow-up that the prosthesis had been worn for any period of time. An unsuccessful prosthetic outcome was defined as a child and parents who were lost to follow-up or who claimed at the time of the most recent follow-up that the child never wore the prosthesis. Survival analysis was performed.
Results:
An unsuccessful prosthetic outcome was noted for 127 children (49%). Initial fitting prior to the age of three years was associated with improved prosthetic outcome (p < 0.001). With the numbers studied, there was no additional benefit noted for fitting before one year of age (p = 0.60). Improved prosthetic outcomes were noted in children who had received intensive training at the time of fitting with an active terminal device (p = 0.005). Provision of a variety of prosthetic designs over the growing years was also associated with improved prosthetic outcome (p < 0.001).
Conclusions:
This study supports the initial prosthetic fitting for a child with unilateral congenital below-elbow deficiency prior to the age of three years, the provision of intensive training under the direction of an occupational therapist when an active terminal device is applied, and utilization of a variety of prosthetic designs over the child's years of growth. Further analysis of outcomes for the prosthetic management of these children will require more precise definitions of outcome in multiple domains and the development and validation of specific outcome instruments.
