The acceptance and rejection of prostheses by children with multiple congenital limb deformities.

1 Director, Mary Marlborough Lodge, Disabled Living Research Unit, Nuffield Orthopaedic Centre, Oxford, England. 2 Research Assistant, Department of Engineering Science, University of Oxford, Oxford, England. 3 Mary Marlborough Lodge, Disabled Living Research Unit, Nuffield Orthopaedic Centre, Oxford, England. 4 Chairman, Department of Orthopaedics, University of Virginia School of Medicine, Charlottesville, Va. 22901; Visiting Professor to the Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford, England. C H I L D R E N with severe multiple congenital limb deformities associated with thalidomide are numerically few (22,48). Because of the severity of this disability, the associated deformities, and the psychological trauma to both parents and child, the thalidomide tragedy has served as a catalyst to study the congenital amputee in depth. There is still controversy concerning the appropriate prosthetic and rehabilitation program for these children, but the attention this tragedy has focused on other less-involved children perhaps will reap benefits far beyond our expectations (1,13,18,23,26,36,39,42). The possible factors associated with acceptance or rejection of appliances may be inherent in the appliance, or they may arise from the child's own frustration, the parental reaction (15,20,43), or other environmental factors. Retrospective studies of children who attend the Nuffield Orthopaedic Centre for prosthetic management and a review of the relevant literature have been carried out in an effort to establish a pattern of management and to delineate topics for future research.