In congenital hand surgery, the main classifications are mostly based on the bony appearance of the congenital hand difference (Blauth, 1967; Manske and McCarrol, 1992; Wassel, 1969], since documentation of the differences and communication between colleagues through radiographs is more reproducible than through pre- and peroperative notes. However, in classifying in a skeletal mode, the spectrum of soft tissue differences are neglected, which cannot necessarily be appreciated on the basis of the bony differences. In the hypoplastic thumb, this has been acknowledged by experts in the field, and as a result modifications were designed of the first grading system, as described by Blauth (1976).
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