Introduction <p>The outcomes of pollicization is cases with severe radial longitudinal deficiency in younger children have rarely been studied. The study is focused on the functional outcomes of early pollicization in children with radial longitudinal deficiency and anomalous index fingers.</p> Methodology <p>We conducted a retrospective analysis of data involving children with radial longitudinal deficiency who underwent pollicization with a minimum follow-up period of 1 year, and a control group of age-matched children with typical hand development. The objective assessment comparing cases and controls included assessment of hand function by modified Percival score, angle of first web space, pre-op presence of index finger anomaly, maximum abduction of pollicized finger, and PIP joint flexion of the pollicized finger.</p> Results <p>The study group consisted of 18 patients and 22 pollicizations. The results of the modified Percival score was 13.73(SD 1.88) in the study group and 15.65(SD 1.04) in controls. Even though differences between the study group and controls were significant (<i>p</i> 0.0002), the functional outcome was averaged at good according to modified Percival score. The angle created at the first web and maximum radial abduction of the pollicized finger were comparable to the control group. Proximal interphalangeal joint flexion remained unchanged post-operatively in comparison to controls (mean 30.1, SD 7.56).</p> Conclusion <p>Pollicization significantly improves hand function in severe cases of radial longitudinal deficiency, even in the presence of anomalies of the digits if done early enough, and is a truly worthwhile life-changing option. Future studies may focus on refining surgical techniques and post-operative rehabilitation protocols to further optimize outcomes.</p>