Gaining the Upper Hand: Understanding the Causes and Repercussions of Delayed Presentation of Congenital Hand Anomalies.

Congenital upper extremity anomalies are common, with an incidence of 27.2 per 10,000 births.¹ This case series highlights patients with delayed presentation of congenital hand anomalies due to breakdowns in referral to pediatric hand surgery. A retrospective review of patients with congenital hand anomalies with delayed presentation to the University of Mississippi Medical Center Congenital Hand Center was performed, and 3 patients were included. Delays in care result from a variety of missteps for patients and parents navigating the health system. In our case series, we observed fear of surgical correction, lack of expected impact to quality of life, and paucity of knowledge of available surgical options by the patient's pediatrician. While all patients underwent successful reconstruction of their congenital hand anomalies, these delays in care resulted in more demanding surgeries and prolonged return to normal hand use. Early referral to pediatric hand surgery for congenital hand anomalies is critical to avoid delays in care and unfavorable post-operative outcomes. Educating primary care physicians of regional surgeon availability, surgical options, ideal reconstruction timelines, and methods to encourage parents to pursue surgical options early for correctable deformities can improve patient outcomes and lessen resultant social consequences in patients with congenital hand anomalies.