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Uploaded byAbhishekTripathi936984
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ISPO classification.pptx

The document provides an overview of congenital limb deficiency, including terminology, causes, and the ISPO classification system. It discusses various types of congenital deficiencies and the purpose of classification for clinical treatment and research. The ISPO classification helps in defining the characteristics of deficiencies to guide treatment options and better inform patients.

Health & Medicineâ—¦
Congenital Limb Deficiency and ISPO classification Abhishek Tripathi Lecturer, Prosthetics NILD, Kolkata
Objectives A. General introduction to congenital limb- deficiency B. Some example of limb deficiency terminology based on Latin/Greek origin C. Causes of congenital deficiency D. ISPO- Classification of Congenital Limb Deficiency and its purpose a) Constraints for ISPO classification b) Type of congenital deficiency under ISPO classification
(A) Congenital Limb deficiency • A congenital anomaly is a condition of congenital disorder/disease existing at or before birth regardless of cause. It involve defects in a developing fetus • Dysmelia is the congenital disorder of limb resulting from disturbance in the embryonic development – Types: • Aplasia (missing) limbs: – Amelia – Oligodactyly – Congenital limb loss • Malformation of limbs – shortening (rhizomelia or mesomelia), – Ectrodactyly, – Phocomelia, – Meromelia, – Syndactyly, – Brachydactyly, – Club foot
(B) Some example of limb deficiency terminology based on Latin/Greek origin • Oligodactyly (from the Ancient Greek oligos meaning "few" and δάκτυλος daktylos meaning "finger") is the presence of fewer than five fingers or toes on a hand or foot • Oligodactyly is therefore the opposite of polydactyly • Oligodactyly is sometimes a sign or symptom of several syndromes including Poland syndrome and Weyer Ulnar Ray Syndrome
(C) Causes of congenital deficiency • Inheritance of abnormal genes, e.g. polydactyly, ectrodactyly or brachydactyly, symptoms of deformed limbs then often occur in combination with other symptoms (syndromes) • External causes during pregnancy (thus not inherited), e.g. via amniotic band syndrome • Teratogenic drugs (e.g. thalidomide, which causes phocomelia) or environmental chemicals • Ionizing radiation (nuclear weapons, radioiodine, radiation therapy) • Infections • Metabolic imbalance
(D) ISPO- Classification of Congenital Limb Deficiency • Is a nomenclature/classification of congenital limb deficiency published by Dr H.J. B. Day in Prosthetics and Orthotics International journal in 1991 • Congenital (Greek word): before birth • Deficiency: failure of formation
Purpose of “Classification of deficiencies” • Purpose: – To define variables/ characteristics in detail that are affecting the outcome of intervention – To aid clinician to choose the best treatment method – Provide information for useful counseling of the patient and parent about its prognosis – To define the patient population so that to serve for future studies
(a) Constraints for ISPO classification • The congenital deficiency present at birth are described using three constraints: – It is restricted to Skelton deficiency only, i.e. majority of such cases are due to failure of formation – It described on anatomical and radiological basis. No attempt is made to classify in term of etiology, embryology etc – The classically derived term (of Greek/Latin origin) such as Hemi-melia, Peromelia, meromelia etc are avoided
(b) Type of congenital deficiency under ISPO classification (i) Transverse deficiency • Congenitally amputated residual limb so that the limb has developed normally to a particular level, beyond which no skeletal element are present • There may be digital buds at the amputated/ deficient level (ii) Longitudinal deficiency • All other : A reduction, absence of elements with in the long axis of limb
(i) Transverse Nomenclature • Naming the segment at which the limb terminates • Then describing the level with in that segment beyond which no Skelton element exist • Note: This nomenclature should be done with caution in case of disarticulations level/ or when there is full limb segment exist. So that in such cases, the next non- existing Skelton segment is used in the nomenclature. For example: – Transverse deficiency of forearm total: meant congenital absent of limb form the forearm origin and is equivalent to elbow disarticulation.
(ii) Longitudinal nomenclature • There is reduction or absence of element with in the long axis of limb • There may be normal Skelton element distal to the affected bones. • Procedure of naming : – Name the bone affected in proximal –distal sequence by using by using name as Noun. Bones not named is considered as presence – State where each affected bone is total/ Partially – In case of partial deficiency , the fraction & position of bone may be stated – The number of digit should be stated in relation to metacarpal meta tarsal and phalanges, the number starts from pre-axial (along the long axis of the limb, the proximal lost bone should be named first), Radial (in upper limb), Tibial side (in lower limb) – The term ray may be used to refer to a meta-carpal, meta-tarsal & corresponding phalanges
Transverse deficiency of upper and lower limb
Longitudinal deficiency of upper limb
Longitudinal deficiency of lower limb
ransverse deficiency
Transverse deficiency of thigh lower 3rd
Longitudinal deficiency of femur partial, (tibia partial or total)?
Thank you! Ref: AAOS, Atlas of limb deficiency and amputation