Our team in the Comprehensive Limb Difference Program at Children's Healthcare of Atlanta uses a multidisciplinary approach to care for and treat children, teens and young adults with limb differences. Whether the condition is congenital or acquired, it’s important to get the right care as early as possible. 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. We also focus heavily on emotional well-being and offer services like support from child life specialists to help our patients and their families.
Limb differences can include deficiencies, deformities or discrepancies that make a limb appear different.
A limb deficiency is when a child’s leg, arm, hand, finger, foot or toe is crooked, uneven, partially formed or even missing. It can affect the whole limb or just part of the limb and can be congenital (present at birth) or acquired (the result of a disease, accident or other trauma).
A limb deformity is a misshapen limb. A deformity can affect the appearance and function of upper limbs like the arms, hands and fingers, as well as lower limbs like the legs, feet and toes.
Limb length discrepancy
If a child has a limb length discrepancy, which means the limbs are uneven, it may be caused by limb deficiency problems or complications from broken bone growth plates and may be the result of:
- Failure of formation.
- Abnormal formation.
- Too many bones and fingers.
- Too few bones and fingers.
What causes congenital limb differences in children?
The cause for most limb deficiencies, deformities and discrepancies is unknown, but it’s assumed that amniotic bands could be a cause of limb deficiency in upper or lower limbs. Others may be inherited, although this is rare. For some limb differences, however, there may be underlying bone problems like rickets, which can lead to bent bones, or osteogenesis imperfecta (brittle bone disease), that can lead to deformities from multiple fractures.
Simply stated, a child's limb difference or deficiency can be the result of:
- Lack of formation in utero.
- Abnormal formation in utero.
- Too many bones and fingers forming in utero.
- Too few bones and fingers forming in utero.
- Amniotic bands tightening around limbs, restricting growth.
No matter the cause, children with limb differences are all unique, which means their treatment should be individualized to meet the needs of each child and family.
Our team created a private Facebook groups for limb deficiency families.
This Facebook page offers an online resource for sharing advice, seeking recommendations, celebrating milestones (of all sizes!) and getting to know each other.Learn More
We treat babies, kids and teens who are affected by congenital conditions that cause limb deficiencies, deformities and discrepancies. Typically, congenital limb difference is not genetic, but some types of congenital limb difference are hereditary. Depending on the age and goals of a patient and family, a prosthesis can also be worn. These conditions can affect the entire upper and lower parts of the limbs, or just parts of those limbs, including:
National and international research is a top priority for Children’s
Our comprehensive limb difference team wants to provide better outcomes for limb difference patients through collaboration and research.Learn more
Some limb differences may be acquired, which means they develop over time or happen because of an injury, such as a fracture, accident, infection, tumor or condition effecting the bone’s formation and growth.
Post-traumatic limb deformity (fracture)
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 whether 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 specialists 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, infection or bone tumor. The majority of amputations happen because of trauma. Our team offers a multidisciplinary approach to caring for children, teens and young adults who need a limb amputated.
Tumors and infections
Some types of tumors that may require amputation include osteosarcoma, Ewing’s sarcoma and rhabdomyosarcoma. Your child’s care team will work to understand the type of treatment that will be best in his case. Determining 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.
A New Musculoskeletal Tumor Clinic
Our multidisciplinary Musculoskeletal Tumor Clinic brings together orthopedic surgeons, hematology oncology physicians and physical therapists who are specially trained to treat kids with sarcomas (bone tumors).Call for Details
The Comprehensive Limb Difference Program team at Children’s offers a collaborative approach to limb difference treatments and customizes plans for each patient, including pediatric orthopedic specialists, physical therapists and orthotists to help make sure your child’s limbs remain as functional as possible. Treatment options include:
The Comprehensive Limb Difference Program at Children’s includes pediatric orthopedic surgeons, as well as pediatric physical therapists, prosthetists and orthotists to help make sure your child’s limbs remain as functional as possible.
Our surgeons have additional training in limb lengthening and reconstruction 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.
Contact our Comprehensive Limb Difference ProgramPhone: 404-785-5684
- Jorge A. Fabregas, MD, Co-Lead, Comprehensive Limb Difference Program
- Jill C. Flanagan, MD, Co-Lead, Comprehensive Limb Difference Program
- Robert W. Bruce Jr., MD, Medical Director, Neuromuscular Program and Cerebral Palsy Program
- Dell C. McLaughlin, MD, MPH
- Dana Olszewski, MD, MPH
- Michael L. Schmitz, MD, Chief, Orthopaedics and Sports Medicine Center
Contact: 404-785-KIDS (5437)
- Colleen P. Coulter-O'Berry, PT, DPT, PhD, PCS
- Jill Cannoy DT, DPT, PCS
- Brian Giavedoni, MBA, CP, LP
- Rebecca Hernandez, CPO, LPO
- Richard Welling, MSPO, CPO, LPO
- Brian Emlling, PO, LPO
Private practice physicians in our Orthopedics Program
We work closely with private practice physicians in our program to lead research, develop specialized programs and deliver seamless care to patients.Hand surgeons
Contact: 404-785-HAND (4263)