Purpose: Apert syndrome is a rare congenital disorder characterised by unique craniofacial and upper limb abnormalities. The hand deformities are some of the most complex and challenging congenital upper limb abnormalities to manage. Surgical correction aims to create a four or five digit hand to improve function and aesthetics. The patient’s cognitive state, social circumstances and other syndromic abnormalities make successful outcomes challenging to achieve. The nail unit represents a challenge as it is important for aesthetics and pinch grip but will continue to grow and require regular maintenance through life. This study seeks to examine the long term outcomes after surgical correction of the hand abnormalities in Apert syndrome and how the nail plate unit is best managed. Methods: A literature search was undertaken. Results: Several articles were found with most pertaining to the different techniques available, with little on the functional outcomes or how the nail plate should be managed. Overall, the outcomes for hand function after surgical correction were very good in those that received wholistic lifelong care in a multidisciplinary set up. Conclusion:The optimal surgical treatments of the hand in Apert syndrome remains elusive and further research is needed to examine the long term outcomes. The Australian Hand Difference Registry may address some of the short comings in congenital hand surgery research in the future. Until more definitive research is completed, consideration of the functional and aesthetic role of retaining the nail plate as well as its potential impact on self care and reliance on others, should be considered