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The first stage included excision of the proximal interphalangeal joint and osteotomy of the thumb metacarpal, and aimed to restore a correct thumb length, position and alignment and to create a wide thumb web space. The second stage consisted of an opponensplasty with refining of any of the first stage components, as necessary. The mean age at surgery was 3.2 years (range, 2.5\u20136 years). After a mean follow-up period of 42 months (range, 26 months to 7 years), the targets of treatment had been accomplished without loss of growth potential, joint stability or thumb motion. 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