Young Attending’s Corner: The Unique Privilege of Caring for Patients with Congenital Limb Deficiencies

While orthopedic training can prepare you for the nuts and bolts of surgery (sometimes literally), as a new attending, what I have been most struck by in my transition to practice is the unique honor, responsibility, and opportunity it is to take care of all our patients, but especially those with congenital limb deformities and differences.

Congenital limb differences encapsulate a wide array of anomalies, with length discrepancies; angular deformities; missing, underdeveloped or extra bones; unstable joints; and abnormal foot positioning all falling under this umbrella term. What I’ve found, though, is that despite the anatomic differences, there is a unity of experience that binds these patients and families together. Having a child with a deformity detected in utero or at birth can be devastating news for a parent, and while the details of how to treat each one varies, our fortunate position to be able to console, inform, and empower these families remains the same. At a time that may feel overwhelming and uncertain, we can provide these families both a path forward and the assurance that we will be there to guide them every step of the way.

Many children with congenital deficiencies and deformities will require many surgeries for reconstruction over the course of childhood. While for some, amputation or amputation equivalents may be the most functional course of treatment, just in the past decade the technology available to lengthen, reconstruct, and salvage limbs has increased by leaps and bounds, and our knowledge of the deformity field has expanded commensurately. While amputation and prosthetic fitting may best suit the needs of individual patients, for those who would prefer to avoid it, we have ever-evolving technologies that have pushed the boundaries on what was previously deemed a salvageable limb. External frames remain a staple of the deformity surgeon’s armamentarium, but internal lengthening devices have proven better tolerated and easier to use by patients whose anatomy can accommodate them. With the ability to do multiple short segment lengthenings, there is no longer a clear limit on how much discrepancy is too much to reconstruct. For complex, multiplanar deformities, the efforts of giants in the field to provide us new classifications, treatment strategies, and techniques has afforded a breadth of surgical tactics from which to draw to treat these patients at every stage of growth and development.

I’ve had the immense opportunity to see how resilient, functional, and happy our congenital deficiency patients can be despite their physical differences at birth. The ability to express that hope, that expectation, for a joyful, fun, and active childhood to a parent looking toward an uncertain future is one of the great privileges of this career. Reconstructing the limb of a patient with a severe congenital deficiency can be a long road to travel, and we are now able to provide parents a map of the path forward and travel it with them.