[Prosthesis for upper extremity congenital deformities]

Prosthetic fitting, in the case of upper extremity congenital deformity, is still subject to controversy. While some authors recommend early systematic fitting, others are not in favour of doing this systematically, denying any advantage in fitting a prosthesis early on. As always, the truth is located between these two extremes. We are not in the logic of the restoration of a lost function. The present situation must be taken into account, but above all, it is necessary to think about the future not to compromise the socialization of these children when they become adults. The proposal of a fitting should never be seen as a constraint by the parents, and even less so by the child. The decision will result from a multidisciplinary reflection with the parents and together with the surgeon, the physical and rehabilitation medicine (PRM) doctor, the physiotherapist and the prosthetist. The fitting can be either aesthetic or functional. Aesthetic fitting is not totally without function, and the child quickly integrates the prosthesis into his daily activities. Functional fitting may only be considered using powered equipment and electric motorization. Early fitting (before four years old) allows the child to build his schema by integrating the prosthesis without it being seen as a constraint. The future desire of wanting a prosthesis is thus safeguarded. A child who has already been fitted can, in adulthood, choose freely to either continue to wear the prosthesis throughout the day or punctually, on certain occasions, or refuse fitting with full knowledge of the facts.