1. Congenital Limb Deformity

- 60%

- rare for UL

- PFFD / Tibial Hemimelia


2. Tumours 


3. Trauma 

- 26%






Diaphyseal amputation removes one of physes

- progessive LLD




1. Preserve physis via disarticulation

2. Preserve as much bone length as possible




Terminal overgrowth of stump

- occurs when appositional growth of bone exceeds that of surrounding soft tissues

- may result in penetration of bone through skin

- occurs in 10%

- most common in humerus, fibula, tibia & femur



1. Stump revision with adequate resection of bone + myoplasty

2. Autogenous osteochondral stump capping 


Phantom Limb sensation


Always occurs in children

- < 10 years old settles rapidly

- not painful usually




Should coincide with normal motor skill development


Upper limb


Age 4-6 months

- when sitting balance required

- passive terminal device


Age 2-3 years

- add active cable control with voluntary terminal opening device

- when starts object manipulating with terminal device


Lower Limb


Age 8-12 months

- terminal device

- for AKA, add knee device when child walking well


Age 5-6 years

- more elaborate devices

- gait retraining