Our Approach to Limb Treatment

Our Comprehensive Limb Program provides care for children, teens and young adults who have crooked, uneven or missing limbs. Whether the limb difference is congenital (present at birth) or acquired (the result of disease, an accident or other trauma), it’s important to get the right care as early as possible. Children with limb differences are all unique, which means their treatment should be individualized to meet the needs of each child and family. 

We offer comprehensive evaluation, surgical intervention, state-of-the-art prosthetic and orthotic devices, and therapy to meet the ongoing functional demands of growing, active children and teens with limb differences.

Limb Conditions We Treat

What are limb deficiencies and deformities?

Limb deficiency

A limb deficiency is when a child is missing part of or all of a leg, arm, hand or foot. Limb deficiencies can be congenital (present at birth) or acquired (the result of disease, an accident or other trauma). Limb deficiencies can affect the whole limb or just part of the limb.

Limb deformity

A limb deformity is a misshapen limb. A deformity can affect the appearance and function of upper limbs like the arms and hands, as well as lower limbs like the legs and feet.

Limb length discrepancy

Limb length discrepancy means there are differences in limb lengths. These differences can be caused by limb deficiency problems or complications from broken bone growth plates.

  • Failure of formation
  • Abnormal formation
  • Too many bones and fingers
  • Too few bones and fingers

What causes congenital deformities and deficiencies?

We may not always know the reason why a deformity or deficiency exists at birth. The cause for most limb deficiencies is unknown. Some deficiencies happen because of exposure to certain drugs while the baby is in the womb. Other deficiencies may be inherited, although this is rare. For some deformities, there may be underlying bone problems, such as rickets, that can lead to bent bones or osteogenesis imperfecta (brittle bone disease), which can lead to deformities from multiple fractures.

Congenital conditions

We treat babies, kids and teens who are affected by congenital (present at birth) conditions that cause limb deficiencies and deformities. These conditions can affect upper and lower parts of the body, including:

Elbow

  • Above the elbow: This is an arm difference that occurs during development in utero in which a portion of the arm above the elbow does not develop properly. This can occur immediately above the area where the elbow may be or higher up the arm, and it typically involves only one arm. 
  • Below the elbow: This is an arm difference that occurs during development in utero in which a portion of the arm below the elbow does not develop properly. This can occur anywhere along the length of the forearm and typically involves only one arm. 

There is no family or genetic link to these conditions. Surgery can sometimes be performed to provide better coverage in thin-skinned areas, remove skin “nubbins” or occasionally elongate the bone for a prosthetic fitting. Depending on the age and goals of the patient, a prosthesis can be worn.

Forearm

  • Radial deficiency: There are two bones that make up the forearm. When all or a portion of the radius (the bone on the thumb side of the forearm) is missing, this can be due to a condition known as radial longitudinal deficiency. When this condition is present, there may also be a spectrum of problems with the thumb ranging from normally functioning to absent thumb. This can sometimes occur spontaneously, but it often is associated with syndromes, such as thrombocytopenia absent radius (TAR); Holt-Oram; TBX5 deficiency; vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies and limb abnormalities (VACTERL); or Fanconi’s. Surgery is often performed to improve overall alignment of the wrist. If other differences exist, such as the thumb, surgery can be performed in order to help its function or create a finger to work like a thumb.
  • Ulna deficiency: When all or a portion of the ulna (the bone on the small finger side of the forearm) is missing, this can be due to a condition known as ulnar longitudinal deficiency. Small and ring fingers may also not develop. This condition occurs sporadically and surgery may sometimes be performed to improve the position of the wrist and forearm.

Hand and Fingers

  • Amniotic band: This condition occurs when a baby is born with multiple band-like wrappings around the arms. This can result in amputated fingers, connected fingers (syndactyly) or nerve dysfunction depending on where the band-like wrappings around the arms are located. The cause is unknown and happens sporadically.
  • Camptodactyly: This occurs when a finger is unable to be straightened out. It most commonly occurs in the pinky. It is a spontaneous condition, but can be genetic. Management is commonly conservative, with stretching and splinting as directed by therapy. When shortening of the muscle or bone is severe, surgery is occasionally performed to help straighten the finger.
  • Cleft hand: Children may be born with a widened space between their fingers or missing middle fingers. This condition is known as cleft hand. This is typically a genetic condition, but it can occur spontaneously. Some children may function well with grasp and may not need surgery to improve this function. When treated surgically, reconstruction can be performed to narrow the webbed space between the fingers.
  • Cleft hand, atypical symbrachydactyly: This is a condition where the hand may be smaller than normal and fingers may not fully form and be interconnected. The fingers can vary in length and function. The thumb is usually spared and typically only one hand is involved. This occurs spontaneously, or in association with Poland syndrome. Surgery can sometimes be performed to help the hand pinch better. Examples of surgery may include deepening the thumb webbed space, finger lengthening or a toe-to-finger transfer. Surgery varies from hand to hand. Prostheses may be helpful for certain activities on a patient-specific basis.
  • Clinodactyly: This is when just the tip of a finger is curved, typically in the direction pointing toward the thumb. This can occur spontaneously, genetically or in association with Down syndrome. The finger typically functions very well. Surgery may be considered for fingers that overlap when trying to grip. 
  • Klirner: This is when the tip of the finger has a more curved appearance than other fingers. It is a spontaneous condition but can be genetic. These fingers typically function very well. Surgical intervention may be warranted if the shape of the finger impedes function.
  • Syndactyly: This is a condition in which two or more fingers are stuck together, have no webbed space and are incapable of being separated. Fingers often remain attached by skin only, but sometimes the bones, nerves and blood vessels can be involved between two fingers. The cause of this condition can be spontaneous, genetic or occur with other conditions. In most circumstances, surgery can be performed to separate the fingers. There is usually not enough skin to split the fingers, so skin is usually taken from somewhere else on the body to help cover the deficit. When bones are involved, separating fingers may compromise the function of the hand.

Hip, Leg and Knee

  • Achondroplasia (dwarfism)
  • Amniotic band: This condition occurs when a baby is born with multiple band-like wrappings around the legs. The cause is unknown and happens sporadically. 
  • BowlegsThis is a condition in which the knees point away from the center of the body. Many young children normally have bowlegs that correct at about age 2. This is referred to as physiologic bowlegs. However, there are two conditions in which bowlegs do not correct in young children: infantile Blount’s disease and rickets. Both of these problems can be diagnosed with an X-ray. If your child still has bowlegs by age 2, it is important to have him evaluated for underlying conditions that may be causing the bowlegs.
  • Congenital femoral deficiency (also known as proximal femoral focal deficiency)
  • Coxa vara: In this condition, the angle between the top of the femur (thigh bone) and the hip joint is too small. This results in the top of the femur pointing down toward the body. Coxa vara is a decrease in the angle of the top part of the femur bone. It involves the neck of the femur, which is the part between the ball portion at the top of the femur (head) and the long, straight portion of the femur (shaft). Typically, the angle between the neck of the femur and the shaft of the femur is 135 degrees. When a child has coxa vara, this angle is less than 120 degrees.
  • Dislocated knee: A condition in which a baby is born with the knee and the femur bone not connected. The leg is stuck in a straight position.
  • Fibula hemimelia (or fibula deficiency)
  • Intoeing (pigeon-toed)
  • Knock knees: A condition in which the knees point inward and touch. In most cases, knock knees resolve by about age 6. However, if the crookedness does not resolve on its own and continues to worsen, treatment may be needed to correct the deformity.
  • Morquio’s syndrome
  • Tibia hemimelia (also known as tibia deficiency)

Feet

Acquired limb deformity or deficiency

Some deformities can be acquired, which means it develops over time or happens because of an injury, such as a fracture, or can happen because of an infection or a tumor.

Post-traumatic limb deformity  

A post-traumatic limb deformity is a limb that becomes crooked after a bone is broken. In some cases, the bone may heal in a crooked position, which is known as a fracture malunion. Other times, the fracture may heal straight, but the bone’s growth plate is partially damaged. This causes the bone to heal crooked or grow at a different length than the opposite limb.

In children, fracture malunions are often not a problem if the crookedness is not causing any pain or the child can still use the limb normally. This usually happens if the fracture is close to the growth plate but does not affect the growth plate. Infections may also affect a bone’s growth plate.

If your child has recently had a fracture or infection involving the growth plate, your doctor will follow the growth of your child’s limb for at least six to 12 months to determine if there are any problems. Some types of deformities do not need treatment and get better over time. In some children, a crooked bone will not improve its alignment as it grows, and it will become painful or cause functional problems. If this is the case, your child’s doctor can talk to you about options to straighten the bone.

Post-traumatic limb deficiency (amputation)

Our team of experts understands how to deal with traumatic events that may require amputation, rehabilitation and follow-up care. Acquired amputations happen most often as a result of trauma or infections. The majority of amputations happen because of trauma. Our team offers a multidisciplinary approach to caring for children, teens and young adults who need amputations.

Tumors and infections

Some infections may require amputation so that the disease does not spread. Tumors can also result in the need to have surgery on or amputate a limb.

Some types of tumors that may require amputation include osteogenic sarcoma, Ewing’s sarcoma and rhabdomyosarcoma. Your child’s care team will work together to understand the type of treatment that will work best in his case. To determine whether a limb can be saved depends on how aggressive the tumor is, the stage of the tumor, how effective other medical treatments have been and whether there is a good chance the surgeon can remove all of the tumor.

If surgery is determined to be the best approach for treatment, our team offers a range of treatment options as part of our Bone and Soft Tissue Sarcoma Program.

Treatment Options

Our team offers a collaborative approach to treatment and customizes plans for each patient.

Orthotics

Our orthotics team creates custom fit braces and splints to help patients with limb deformities and deficiencies.

Prosthetics

Our orthotics and prosthetics team provides some of the most advanced technology available in designing and fitting prostheses, including myoelectric and conventional prostheses for upper and lower extremities.

Limb prostheses are designed to meet the functional demands and needs of children with limb loss. There is no right or wrong decision when it comes to whether a child should wear a prosthesis.

Understanding the types of prostheses available for the level of limb loss helps a child and their family make the decision that is right for them. Options for prostheses include non-articulating functional prostheses, body-powered prostheses, myoelectric prostheses and activity-specific prostheses. Our team also offers prosthetic training provided by therapists who are experienced in working with children, teens and young adults during all stages of prosthetic fitting.

  • Non-articulating functional: These prostheses are generally worn to give children equal arm lengths and help with simple tasks, such as propping, support, balance, and trunk and upper arm strengthening, as well as the appearance of the arm. Simple grasp may be an option depending on the type of hand made with the prosthesis.
  • Body-powered: Body-powered prostheses provide grasp and release functions that operate a terminal device with a cable and harness. Tension on the cable either opens or closes the terminal device: prosthetic hand, prehensor or hook.
  • Myoelectric: A myoelectric prosthesis is an active, electrically powered prosthetic device that allows children to open and close a prosthetic hand for grasp and release functions. Small electrodes are built into the socket, which detects signals from the muscles under the electrodes. The signal from the muscle helps control the speed and degree of opening. This technology helps increase independence, while also providing a more natural appearance than many conventional prostheses. As children grow, the ability and appearance of the hand becomes more important to them. This technology is well-suited for teens though adulthood. Using specially designed computer software, patients can program grip patterns and select other hand features, in many cases using gesture control—an advanced option that allows the wearer to change hand patterns with a simple gesture. We offer two types of myoelectric prosthesis: one for full-hand deficiency and another for partial-hand deficiency.
  • Microprocessor: For our older patients, advanced innovative prosthetic devices are available that provide independent movement of each finger, as well as a stronger and faster grasp, and release functions. These include the I-Limb, Michelangelo, BeBionics and various other advanced options. The Children’s Comprehensive Limb Difference Program was one of the first providers in Atlanta to offer advanced microprocessor upper extremity prosthetic technology.
  • Sports, recreation and activity-specific prostheses: These prostheses are designed to help children perform a specific task or sport. They help children participate in activities that require two hands for grasp and movement.
  • Silicone restoration: These prostheses are highly cosmetic, real-life stylized non-articulating functional prostheses. They provide patients who have a partial or complete loss of an extremity—hands, feet, fingers or toes—with a unique and realistic replacement prosthesis. The silicone can be sculpted and painted to match each patient’s size and skin tone, including details like wrinkles, veins and freckles. Silicone skins can be made to go over prostheses, including below-knee or above-knee leg prostheses. As the child grows, the silicone prostheses can be resized for a consistent appearance. Silicone prostheses require specialized fabrication that takes extra time for the customization.

Rehabilitation

The rehabilitation team at Children’s is trained and experienced in working with children who are undergoing limb-lengthening, limb-salvaging procedures or prosthetic training.

Surgery

Our surgical team is specially trained to treat children, teens and young adults with limb conditions.

  • Amputation
  • Hip reconstruction
  • Limb lengthening, including expertise in Precice Nail and Taylor Spatial Frame Constructs
  • Limb-sparing surgery
  • Rotationplasty (for bone tumors)
  • Repositioning bones and fingers
  • Straightening bones and fingers
  • Transferring fingers and toes
  • Targeted muscle innervation

Targeted muscle reinnervation

Our hand and upper extremity orthopedic surgical specialists currently offer targeted muscle reinnervation. The Children’s Comprehensive Limb Difference team is can support the prosthetic and rehabilitation needs of the patients who have had targeted muscle reinnervation as part of surgical reconstruction.

Meet Our Team

Our surgeons have received additional limb-lengthening training and remain active in the limb-lengthening and deformity communities. This helps make sure your child receives the most up-to-date and informed treatment possible. Many of our surgeons are also members of the Association of Children's Prosthetic-Orthotic Clinics (ACPOC) and the Limb Lengthening and Reconstruction Society (LLRS).

The Children's Comprehensive Limb Difference Program expertise goes beyond the surgeons. It also involves working with our pediatric physical therapists and orthotists to help make sure your child's limbs remain as functional as possible.

Children's Physician Group

Orthopaedic surgeons

                                                                    Make an appointment

Physiatrists

Physical therapists

Prosthetists

Community Providers 

Our program consists of employed doctors, surgeons, physical therapists, orthotists and prosthetists, as well as community providers whom we work closely with to help make sure care is delivered seamlessly at our hospitals.

Community providers who participate in the Limb Deficiency Program include:

​Hand surgeon

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