The child with terminal transverse partial hemimelia: a review of the literature on prosthetic management.

This independent-study honors project dealt with congenital skeletal limb deficiencies. This paper discusses and reviews the literature concerning the prosthetic management of the individual with unilateral terminal transverse partial hemimelia of the upper extremity. Specific topics considered are: a general description of the entity, including etiology and incidence; psychological factors affecting the limb-deficient child and his parents; normal and abnormal biomechanics of the upper extremity; components of the prosthesis (terminal devices, wrist units, elbow hinges, cuffs, harnessing, and sockets); prosthetic prescription and fitting; the trend toward early fitting; preprosthetic therapy; and prosthetic training. One section discusses the information elicited from a survey conducted by letters and questionnaires that were sent to the 28 clinics participating in the Child Prosthetics Research Program, conducted under the auspices of the Subcommittee on Child Prosthetics Problems of the Committee on Prosthetics Research and Development to ascertain the age of the congenitally skeletally limb-deficient child at the time of his initial fitting for a prosthesis. An analysis of the data from the 12 clinics replying is presented, along with the developmental criteria for fitting. The scope of this paper is limited to the unilateral upper-extremity, below-elbow congenital amputee. Bilateral amputees, cineplasty, surgical conversion, or externally powered prostheses are not considered. The literature review was limited by time to the books and journals published in 1960 or later, with selected earlier articles. Articles published before 1960, as well as those not available at the Albany Medical College Library or through the inter-library loan system, are listed in the "Bibliography." Both reference lists were compiled from Index Medicus; Amputees, Amputations, and Artificial Limbs (published by the Committee on Prosthetic-Orthotic Education of the National Academy of Sciences—National Research Council, Washington, D.C.); and the bibliographies of articles I reviewed. Terminal transverse hemimelia indicates congenital absence of the entire distal part of the limb below the elbow. The term is part of the modified Frantz-O'Rahilly (10,11,38) classification nomenclature. Hemimelia is the absence of a large part of a limb, from the Greek melos meaning limb and hemi, half. Partial hemimelia indicates that less than half the limb is missing. The defect we are considering is transverse rather than longitudinal, presenting a short or very short stump similar Artificial Limbs, Vol. 16, No. 1, pp. 20-50 Spring 1972