Forearm lengthening and prosthetic management in children with transverse congenital forearm deficiency

Area of Science:

• Orthopedic surgery
• Pediatric reconstructive surgery
• Biomedical engineering

Background:

• Transverse congenital forearm deficiency presents challenges in achieving optimal prosthesis fit during childhood.
• Ulnar lengthening is explored as a surgical intervention to enhance prosthesis fit.

Purpose of the Study:

• To evaluate the efficacy of surgical ulnar lengthening in children with transverse congenital forearm deficiency.
• To assess the subsequent impact on prosthesis fit and functional outcomes.

Main Methods:

• Retrospective review of four pediatric cases undergoing ulnar lengthening.
• Evaluation of surgical parameters: duration, length gain, healing index.
• Assessment of functional outcomes: elbow range of motion, Prosthetic Upper Extremity Functional Index (PUFI), and daily prosthesis usage.

Main Results:

• Mean age at surgery was 3.5 years, with a mean lengthening duration of 58.3 days and mean length gain of 21 mm.
• Elbow range of motion was preserved in most patients, but daily prosthesis use was limited (88.4% of activities performed without prosthesis).
• Functional outcomes indicated limited reliance on prostheses for daily activities.

Conclusions:

• Forearm lengthening in pediatric cases of transverse congenital forearm deficiency has a high complication rate and shows limited daily prosthesis use.
• The primary indication for ulnar lengthening should be a severely short ulna preventing prosthesis fitting.
• Consideration should be given to performing ulnar lengthening later in life, during adolescence.