Congenital limb deficiencies.

In the last 25 years great advances have been made in the management of children with congenital limb deficiency. An understanding of the embryology and development is essential for careful planning and management of these children. It is important to have an internationally accepted classification so that the results of treatment can be compared. In this paper, the international classification of congenital limb deficiency is described. Unfortunately, this is still not widely used by the orthopaedic surgeons. It is hoped that more orthopaedic surgeons will use this classification in future so that we have a common denomination for comparison. Transverse limb deficiency both in the upper and lower limbs can be managed satisfactorily with the aid of prosthesis. Longitudinal limb deficiency which often requires careful planning and judicious use of reconstructive procedure can improve the function considerably. However, some of these children often go through multiple operations and end up with a useless limb. The need for surgical reconstruction is to improve the child's function and this must always be kept in mind. Last but not least the psychological problems both with the child and the parents is of paramount importance. A judicious and sympathetic approach by the orthopaedic surgeons will go a long way in making success or failure of the whole treatment programme.