Congenital Anomaly Discussion

Congenital differences of the upper extremity have an infinite variety of manifestations. Not all benefit from surgery. Surgery may be indicated with the following points in mind. For most patients:

An obviously different hand cannot be made less obvious.

Appearance cannot be made normal if the extremity does not have an essentially normal appearance to begin with.

Parent's expectations will almost always be unrealistic.

Many deformities recur or worsen during growth spurts.

Adults undergoing late reconstruction are often disappointed.

Certain congenital abnormalities may lead to symptoms later in life, render the extremity more prone to injury, or affect the expected outcome following treatment for other regional problems. A cyst in a bone may leave it prone to fracture. Abnormal joints or abnormal connections between bones may develop painful arthritis following relatively minor injury. Abnormal blood supply to bones may lead to dramatic fracture complications. In some cases, the diagnosis of a congenital difference is made only after injury. In this context, it may be impossible to determine the extent to which symptoms were due to injury or to the preexisting abnormality.

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