Classification

The International Society for Prosthetics and Orthotics (ISPO) has adopted a definitive system for congenital deficiencies. No longer is it necessary to learn ancient language roots to describe the limb deficiency (30-32).

Many clinics still describe deficiencies by the Frantz classification system. In this system, deficien­cies are either terminal, representing the complete loss of the distal extremity, or intercalary, denoting the absence of intermediate parts with preserved proximal and distal parts of the limb. Those deficits are then divided into horizontal and longitudinal deficits.

The ISPO classification system is used in research and academic endeavors because this system facili­tates communication and creates a logical, accurate approach. The ISPO classification divides all deformities into transverse or longitudinal. A transverse deficiency has no distal remaining portions, whereas the longitudi­nal deficiency has distal portions. The transverse level is named after the segment beyond which there is no skel­etal portion. Longitudinal deficiencies name the bones that are affected, beginning with the most proximal long bone. Any bone not named is presumed present and of normal form. The affected bone is designated as total or partially absent. The approximate fraction of the limb in a transverse deficiency is estimated in thirds, while the longitudinal deficiencies describe a partial or complete bone absence. Involved digits are then identified. Digit numbering proceeds from the radial or tibial side of the limb. Ray refers to the metacarpal or metatarsal and cor­responding phalanges (33). Tables 13.1 and 13.2 describe transverse and longitudinal deficiencies.

Transverse Limb Deficiencies

Longitudinal Limb Deficiencies

13.1

13.2