Problems and complications in the management of upper limb anomalies.

Nonsurgical problems and complications of orthotist-prosthetist techniques are not addressed in this article. There are a number of complications, such as decubiti, joint contracture or damage, tendon injury, wound healing, etc., which are not discussed because they are similar in cause, identification, and treatment to the same adult problems. Though it is possible to list the more common complications seen for each congenital anomaly, the tedious repetitiveness of such an approach dissuaded the author. General principles can always be specifically applied when the occasion requires. It is also possible to detail painstakingly the techniques of coping with each complication, but such would require book rather than chapter exegesis, and those who need these details are referred to the bibliography. The theme of this article is that there is no longer much distinction in the mind of the consumer clientele between the problem of the congenital anomaly, the results of treatment, and the complications of those treatments. The provider must therefore be wary, extensively informed, and exceedingly communicative, to the point of suggesting secondary consultation as warranted or desired. Despite this almost adversarial approach, the rewards are still great, for more can be accomplished than ever before, the child will seldom show motivational problems in using what is provided, and gratitude is not lost coinage.