Congenital limb deficiencies

Question 1

Classification systems of congenital limb deficiencies

Answer 1

• Failure of formation of parts
• Failure of differentiation of parts
• Duplication
• Overgrowth
• Undergrowth
• Congenital constriction band syndrome
• Generalized skeletal deformities

Question 2

Causative factors of congenital limb deficiencies

Answer 2

• Genetic
• Vascular
• Tetragenic
• Amniotic bands
• Exact cause is unknown

Question 3

Types of lower limb congenital limb deficiencies

Answer 3

• Congenital short femur
• Proximal femoral focal deficiency
• Total absence of proximal tibia
• Present proximal tibia, absent distal tibia, unstable ankle
• Unstable ankle and foot

Question 4

Classic presentation in proximal femoral focal deficiency (PFFD)

Answer 4

• Shortened thigh that is held in hip flex, abd, ER
• Hip and knee contracture
• Foot often is at level of opposite knee
• Severe leg length discrepancy

Question 5

Presentation of longitudinal deficiency of tibia

Answer 5

• Shortened tibia
• Foot positioned equinvarus
• Possible medial ray deformities of the foot
• Active knee extension may be absent

Question 6

Presentation of longitudinal deficiency of the fibula

Answer 6

• Varying degrees of fibula shortening
• Foot in equinovalgus
• Tibia bowing
• Valgus of the knee
• Absence of one or more rays in the foot
• Dimpling of skin over apex of tibia

Question 7

Why are children the best candidates for rotationplasty?

Answer 7

• Bones are still growing
• Able to better adapt

Question 8

Things to consider for surgical procedures in pediatric limb deficiency

Answer 8

• Skeletal immaturity and future growth
• Physes should be preserved when possible
• Limb sparing procedure may be better for function if amputation results in significantly short residual limb
• Lengthening of a short residual limb may increase efficiency of gait
• Amptuation through long bones often result in overgrowth with spike

Question 9

What is the purpose of limb sparring/guided growth?

Answer 9

• To correct angular deformities, limb length discrepancies, without removing entire limb

Question 10

Benefit of limb sparring

Answer 10

• Preservation of limb function
• Minimally invasive
• Reversible

Question 11

What is limb replantation?

Answer 11

Removal of damaged tissue, reconnecting bone ends, repair muscles, tendons, nerves and blood vessels

Question 12

What factors affect successful limb replantation?

Answer 12

• Type of injury
• Extent of tissue damage
• Ischemia time
• Patient health that could affect healing

Question 13

Goals of PT for congenital limb deficiencies

Answer 13

• Parallel normal development
• Prevent joint contractures, weakness, skin breakdown, musle and joint asymmetry
• Proper alignment with weight shifting and balance during mobility
• Gait training with assistive device to help with confidence
• W/C mobility training