This five year multicenter cross-sectional study of the clinical outcomes for children with a unilateral congenital below-the-elbow deficiency was performed at 10 Shriners Hospitals. Four hundred eighty nine children were included; 321 children wore a prosthesis and 168 did not. The parents and children were administered five outcome measures which included demographic information, health related quality of life, musculoskeletal health, subjective assessment of performance of daily tasks, and objective assessment of task performance. Overall, the findings of the study revealed that the use of a prosthesis in children with a unilateral congenital below-the-elbow deficiency did not result in any clinically relevant difference in most scores. In fact, non-wearers performed either the same as or better than wearers on the objective assessment of task performance. In addition, for all age groups combined, non-wearers scored better than wearers of prostheses and the wearers scored higher when they did not wear their prosthesis than when they did wear it. Of note, children and adolescents with unilateral congenital below-the-elbow deficiency scored slightly higher than those for the general population in a physical health domain as well as in the happiness domain (adolescents only).
This study calls into question the accepted practice of early and routine prescription of prosthesis to improve function or quality of life of children with unilateral congenital below-the-elbow deficiency. In this study, prosthetic use did not help children and adolescents with unilateral congenital below-the-elbow deficiency to function and these subjects generally performed better with their prosthesis off. The authors do recognize that some patients may be benefited from the use of a prosthesis and their use may promote social acceptance by altering appearance. They also may be useful as tools for specific high-level activities such as some sports. The fact that these children functioned within a normal range with only one hand calls into question any reported functional improvements associated with reconstruction of other types of unilateral hand malformations. Future studies should be directed towards evaluating standardized subjective and objective measures of reconstruction interventions in children with congenital malformations.
Prosthesis, Congenital, Deficiency, Children, Pediatric
Journal of Bone and Joint Surgery