Congenital Absence or Near Absence

Absence of one or more fingers and toes at birth is not uncommon today, resulting in minimal functional disturbance, rarely needing reparative

Congenital Absence The Fibula

Fig. 2.1. Upper. Congenital absence of the fibula with short tibia, only two foot rays and a foot remnant in non-weight-bearing attitude. Treated at 1 year by amputation and prosthesis. Lower. Gangrenous second toe resulting from poor blood supply and local trauma. Treated by local amputation. (From author's cases.)

Fig. 2.1. Upper. Congenital absence of the fibula with short tibia, only two foot rays and a foot remnant in non-weight-bearing attitude. Treated at 1 year by amputation and prosthesis. Lower. Gangrenous second toe resulting from poor blood supply and local trauma. Treated by local amputation. (From author's cases.)

surgery. It is assumed such defects have a long history and those affected in the distant past were either accepted, unless function was grossly impaired, or they were viewed as a source of malign influence. Total congenital absence of a hand and foot (apodia) or the distal part of a limb (hemimelia), or of a complete limb (amelia) are less common,4 resulting in significant crippling and probable tribal rejection; even in recent times parents have imprisoned such children in a cellar or attic to hide their "failure" from society. More commonly limbs are foreshortened, so-called phocomelia, particularly associated in the 1960s with the ingestion of thalidomide, yet occurring both before and since this epidemic due to unknown factors.5 Phocomelic limbs often bear a hand or foot at their foreshortened limb extremities and, consequently, may function better than amputation stumps. Nonetheless, they present many of the problems of amputees and, without cosmetic prostheses in the past, doubtless were viewed by their peers as cripples. Even today other congenital deformities can be severe, for example, complete congenital absence of the fibula with a deficient foot twisted severely (Fig. 2.1a), for which amputation and rapid mobilisation with a prosthesis in infancy is preferable to repeated surgery in childhood to correct by degrees what, at best, will always prove a crippled short limb requiring, in any event, an orthosis.

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How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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