This is a 3-year-old child from Yunnan. Before surgery, the child had a type IIIC thumb hypoplasia in the right hand-also known as a floating thumb-with very poor function and no movement. After undergoing SMRT semimetacarpal reconstruction, the thumb not only looked better but also became stronger. The child is now able to grasp small balls and even do "pull-ups."
2 years and 1 month post-op
Local hospitals couldn't help, so the parents actively searched for solutions online.
The parents felt deeply uneasy every time they thought about their child's right thumb just hanging there. They had consulted many hospitals locally, but the advice was almost always the same: nothing could be done, and they were told to seek help from a larger hospital.
But passive waiting wasn't their way of doing things. The parents actively searched online for possible treatments.
First Consultation
Is there still a chance to save a floating thumb?
If the floating thumb is large enough, it can actually be preserved. Currently, there are three main treatment options for floating thumb:
1.Index finger pollicization
The thumb is removed, and the index finger is converted into a thumb. The result is only four fingers on the hand.
2.semimetatarsal reconstruction
A vertical half of the 3rd or 4th metatarsal bone from the foot is transplanted to the hand to reconstruct the 1st metacarpal and carpometacarpal joint. However, the child cannot bear weight on the foot for three months, the surgery takes longer, and there is a risk of bone resorption or necrosis. It also leaves a scar on the foot.
3. SMRT semimetacarpal reconstruction
This is a two-stage surgery. In the first stage, part of the second metacarpal bone from the affected hand is transplanted to reconstruct the first metacarpal. About 3.5 months later, the second stage transfers tendons from the ring finger to the thumb to improve function.
Before coming, the parents had already researched treatment options for floating thumb. They wanted to preserve the thumb while minimizing impact on other parts of the body. Therefore, they preferred the SMRT semimetacarpal method.
First Consultation
Extra finger-must they be removed?
This child also had an extra finger-like growth at the floating thumb location. The parents wondered if, since bone was going to be harvested anyway, could the extra digit's bone be used directly?
The answer: yes. In this case, the bone from the extra digit could be used, and since it's the child's own tissue, there would be no rejection. With careful planning, the surgery went smoothly as expected.
Pre-op X-ray
Active training brings powerful results from a tiny thumb
Both the parents and the child were very cooperative. At the consultation, the child's mother said, "We will do everything we can to cooperate." They followed through with the post-op rehabilitation very well.
Unlike traumatic injuries, a floating thumb requires complete functional training from scratch after surgery. This demands a lot from both the child and the parents. After the second-stage surgery and Kirschner wire removal, rehab training was started as instructed.
2 years and 1 month post-op
The mother regularly shared the child's progress with us and adjusted training methods whenever needed. To help the child recover even better, the parents even sent him to a rehab hospital.
2 years and 2 months post-op
From initially holding large, lightweight objects to now grasping small balls, the child's thumb function and strength have improved significantly through consistent practice.
At a recent follow-up, we observed remarkable changes in both function and appearance. Whether it's fine motor tasks like grasping small balls or more demanding ones like doing pull-ups, the child performs them quite well.
With more time, we believe he'll also be able to do tasks such as writing, twisting bottle caps, and using chopsticks with ease.
2 years and 2 months post-op
2 years and 2 months post-op