Timing and decision-making in the treatment of congenital upper extremity deformities.

With growth and development, the hand undergoes profound structural and functional changes. Congenital anomalies lead to development of aberrant functional patterns. Appropriate timing of surgical correction is essential to minimize deformity and prevent development of aberrant function before set patterns of cortical control have occurred. By the same token, certain anomalies should not be treated surgically since such treatment may interfere with function. A clearer understanding of pathologic anatomy of deformities such as radial club hand, hypoplastic thumb, and thumb duplication has enabled a more rational surgical approach. Microsurgery has an increasing role to play in the treatment of these deformities.