Reasons for prosthetic rejection by children with unilateral congenital transverse forearm total deficiency

As many as half of children with unilateral congenital transverse forearm total deficiency (UCTFTD) choose not to wear a prosthesis. In a multicenter study, 489 children and young adults aged 2 to 20 years with UCTFTD and their parents were tested for satisfaction, quality of life, and function. One hundred sixty-eight (34%) of those tested had chosen not to wear a prosthesis. Subjects and parents were asked the open-ended question "What are the reasons for not wearing a prosthesis?" and were allowed to give more than one response. Of the 135 subjects who had chosen not to wear a prosthesis and who responded to the question, the reason most frequently (53%) given was that the prosthesis did not help function. Forty-nine percent reported they stopped wearing it because the prosthesis was uncomfortable. Currently, upper-extremity prosthetic management for children with UCTFTD is a matter of controversy, with some clinicians advocating the need for prostheses to accomplish bilateral hand tasks, particularly in the scheme of normal development. Responses from children who do not wear a prosthesis may aid practitioners in re-evaluating the prosthetic role and potentially improve prosthetic options.