The problem with this child's right thumb is quite severe, belonging to Type IV thumb hypoplasia (floating thumb). The entire thumb is only connected to the palm by a ligament, making it very fragile. Since the thumb is still relatively large, the whole family hoped to save it, preferably restoring it to the point where the child could write with his right hand. After undergoing half palm bone transplantation to reconstruct and preserve the thumb for half a year, their wish came true, and the child can now write without any issues.
Seven months post-surgery, he can write
Saving the thumb fulfills the family's wish
Since the child's birth, the whole family has been on a quest for medical help. They consulted many doctors, but only received two types of responses: either the doctors hadn't encountered such a case and suggested seeking treatment elsewhere, or they recommended Index finger thumb fusion.
This conflicted with the family's wishes; the parents didn't want the thumb to be amputated. Every time the mother took the child out to play, he would hide his hand in his pocket, which brought tears to mother's eyes. This only strengthened the family's determination to save the thumb. Therefore, the family has been searching for the right opportunity to save the thumb.
Initial Consultation
Floating thumb: Can it be saved?
Whether a floating thumb can be saved depends on the specific circumstances. Generally, Type III and some Type IV thumb hypoplasia cases can be saved. Although this child's condition is quite severe, saving the thumb is still meaningful due to its relatively large size.
There are two methods for saving the thumb: metatarsal reconstruction and half palm bone transplantation. The main difference lies in the location from which the bone is harvested, which affects the donor site differently.
Metatarsal reconstruction involves taking half of the third or fourth metatarsal bone from the foot (longitudinally) and transplanting it to the affected hand to reconstruct the first metacarpal bone and the first carpometacarpal joint. However, the foot should not bear weight for three months after the surgery. The operation duration is longer, and both free bone grafting and vascular anastomosis bone grafting carry a certain risk of bone absorption and necrosis.
Half palm bone transplantation reconstruction surgery is mainly divided into two stages: In the first stage, a portion of the bone is taken from the second metacarpal bone of the affected hand and transplanted onto the first metacarpal bone to establish the framework. In the second stage, tendons are taken from the ring finger to reconstruct thumb function.
Initial Consultation
Concerning half palm bone transplantation, the parents had two questions:
(1)Will taking bone from the index finger affect it?
No. Based on long-term follow-up observations, taking a portion of the bone from the second metacarpal bone has had minimal impact on its growth and the activity of the index finger.
(2)Will taking tendon from the ring finger affect it?
Taking the flexor tendon from the ring finger is a very mature procedure. After restoring thumb function, the impact on the ring finger mainly lies in its independent movement. While the ring finger cannot bend independently, it can flex along with the other fingers, like the middle finger.
Preoperative X-ray
Exercise might seem tedious, but persistence yields results
Thumb function cannot be obtained without effort. We reached a consensus with the parents to achieve the maximum function with minimal sacrifice. Therefore, when the child was close to six years old, we performed thumb preservation surgery.
Since the child had no prior experience actively using his thumb, the parents had to gradually guide him through exercises according to the doctor's instructions, helping him re-establish the neural activity of the thumb. At the beginning, the child was not very cooperative, and we advised the parents to be patient. He started with grabbing larger objects and gradually transitioned to smaller items like beans. Later on, they gradually increased the weight of the objects to enhance the effectiveness of the exercises and stimulate thumb growth.
Strength exercises after 7 months post-surgery
Being a big child, he was relatively compliant. After the second-stage surgery and removal of the stitches, the child followed our exercise regimen quite well. Although he initially preferred to use his index finger, once he got used to using his thumb, he started using his right hand more frequently. Now, he has no issues using both hands to grip objects.
Writing with his right hand has been the family's dream. Apart from daily grip exercises, the parents also provided extra writing practice for the child. From the progress observed during each follow-up visit, the child's handwriting has been improving gradually.
Pressing small balls 7 months post-surgery
The child's recovery owes much to the help of his parents. We also believe that through further exercises, the condition of his hands will continue to improve.