This 2-year-old girl had a floating thumb on her right hand, which lacked mobility. It was a severe case of type 3C thumb hypoplasia, which belongs to a more serious type of floating thumb. The mother had a wish for her daughter to be able to write with a pen in the future. After undergoing a two-stage procedure involving partial metacarpal bone transplantation, the mother persisted in helping her daughter with functional exercises. Now, not only has the thumb been preserved, but there are no issues with writing or drawing.
Initial Consultation
The parents didn't want their child to have any regrets and aimed to save the thumb
As the second child in the family, they were eagerly anticipated. However, the baby was born with a thumb problem, which made the mother feel guilty and cry for a long time. They didn't want her to have any regrets, and the family hoped to save her thumb and restore its mobility.
Additionally, the child developed a habit of using the index and middle fingers to hold things, resulting in loose interphalangeal joints and unusually large separation of the fingers on the right hand. This further reinforced the parents' determination to save the thumb.
Initial Consultation
Saving the thumb, is there a cost?
There are two methods for Saving a floating thumb: partial metatarsal bone reconstruction and partial metacarpal bone transplantation.
In their quest to save the thumb, they consulted many hospitals but received suggestions for either pollicization or partial metatarsal bone reconstruction. Concerned about the potential impact on the foot from harvesting bone for partial metatarsal bone reconstruction, they later discovered the option of partial metacarpal bone transplantation and found me.
The two-stage procedure involves grafting a portion of the second metacarpal bone from the affected hand onto the first metacarpal bone during the first stage, creating a "scaffold." The second stage involves reconstructing the thumb's opposition function using the flexor tendon of the ring finger.
Preoperative X-ray
The parents had concerns about the potential impact of partial metacarpal bone transplantation on the hand. In reality, any type of surgery has varying degrees of impact.
If the gains outweigh the losses, then saving the thumb holds value. The thumb accounts for approximately 50% of hand functionality, and having a thumb significantly improves overall hand function. While harvesting tissue from other areas may cause some damage, the overall outcome is positive, with greater gains and relatively minor losses. Post-surgery, there will be a noticeable improvement in hand function.
Therefore, utilizing partial metacarpal bone transplantation is the most suitable method, and the parents were willing to proceed with it.
After the first surgery
Encouraging guidance as a catalyst for functional recovery
The mother is enthusiastic, optimistic, and skilled at encouraging her child, which is crucial for the child's later functional exercises.
The doctor merely creates the conditions for the child, and most of the post-surgery functional exercises require parental guidance. Younger children tend to have lower compliance, coupled with the lack of previous thumb movement experience. At the beginning of functional exercises, parents need to be patient and gradually guide the child to complete them.
Six months after surgery
Encouragement and guidance were given to gradually familiarize the child with using the thumb for grasping. The more exercises she performed, the better it was for reestablishing the motor nerves and promoting hand function recovery.
It is essential to maintain consistent and long-term exercise routines.
Exercise is not a quick process but rather a lengthy journey that requires sufficient patience.
The parents had a clear goal of wanting their daughter to write with a pen in the future. For this reason, they invested a lot of time and effort. Since the completion of the first stage of the surgery, the mother has been encouraging her daughter to use her hand.Despite the tightly bandaged wound, the mother allowed her to start attempting to hold a pen and draw, gradually cultivating her habit of using the right hand.
After the first surgery
After the removal of the Kirschner wire in the second stage, the mother continued to accompany her daughter, encouraging and assisting her with exercises. They initially started with grasping large toys and gradually progressed to grasping smaller items like green beans. This approach not only strengthened her grip but also improved the precision of her grasp, laying a solid foundation for future writing with a pen.
After the second surgery
More than eight months later, during the follow-up examination, it was observed that the thumb had not only grown but also increased in thickness. The strength had improved, and there was significant improvement in the precision of her grasp. She could easily lift a bottle of iodine and handle small objects. The mother was very satisfied upon witnessing the changes in her child's hand.
The child's excellent recovery is a result of the assistance provided by her parents. With continued exercises, we believe her hand condition will further improve.
Third Follow-Up