This is a premature baby, and both hands show signs of thumb hypoplasia. The left hand is slightly affected, classified as Type I thumb hypoplasia. However, the right thumb has no strength at all, which is classified as Type IIIB-a relatively severe type of thumb hypoplasia, known as a floating thumb.
Initial consultation
After birth, because of the thumb abnormality, the parents took her around to seek medical advice, but the suggested plans weren't suitable. They couldn't accept them and kept searching for a better solution.
Although thumb hypoplasia has a relatively low incidence, the floating thumb type is even rarer, about 1/100,000–2/100,000. However, in absolute numbers, quite a few children still suffer from it. Many parents don't know much about treatment options for floating thumb, so here we've selected six common questions parents care about most to help them better understand floating thumb surgery.
1. For floating thumb preservation, is the bone taken from the foot or the hand?
Treatment for floating thumb is generally divided into two categories: preserving the thumb or not. This mainly depends on the specific condition of the thumb. If it has value to preserve, then thumb reconstruction can be considered.
If parents want to preserve the thumb, there are two approaches:
Taking part of the metatarsal bone from the foot to reconstruct the thumb metacarpal.
Taking part of the metacarpal bone from the hand to reconstruct the thumb metacarpal.
Each approach has its own characteristics, and the choice depends on the child's condition and needs.
The parents wanted to minimize trauma for their child. Taking bone from the hand has the least impact. The child can still walk normally and only the hand needs to be protected and cared for, which is also more convenient for the parents. Therefore, bone grafting from the hand is more suitable for them.
Initial consultation
2. If bone is taken from the hand, will it affect other areas?
Although the surgery is limited to the hand, parents worry about whether taking part of a metacarpal bone for grafting will affect other areas.
Since the surgery doesn't involve other parts of the body, the main concern is whether the index finger will be affected. Long-term follow-ups have shown that removing part of a metacarpal does not negatively affect the index finger. The second metacarpal can continue to grow normally, so parents don't need to worry too much.
3. How many surgeries are needed for SMRT half-metacarpal graft reconstruction of a floating thumb?
The SMRT half-metacarpal graft reconstruction requires two surgeries.
The first surgery involves transplanting part of the second metacarpal onto the first metacarpal to reconstruct it. About three and a half months later, the second surgery is performed to transfer the flexor digitorum superficialis tendon from the ring finger to the thumb, giving the child the ability to perform opposition.
4. At what age can a baby undergo floating thumb preservation surgery?
Generally, full-term babies can be assessed in consultation to confirm their growth and development, and then an appropriate surgery time can be decided.
This child is 1 year and 5 months old, but since she is premature, her corrected age is 1 year and 2 months, which is used to determine the surgery timing.
Initial consultation
5. Is floating thumb caused by heredity or prematurity?
The exact cause is still unclear. Since there is no family history, the probability of heredity is low.
It is more likely related to external factors during early pregnancy, such as medications or other influences. In general, floating thumb is not closely related to premature birth.
6. After SMRT half-metacarpal graft reconstruction, will the child be able to write in the future?
Since the right hand is affected by floating thumb, parents are particularly concerned about whether the child will be able to use the hand for daily functions such as writing and using chopsticks.
After surgery, long-term functional rehabilitation is necessary to improve thumb opposition and abduction. As long as the child follows medical advice and practices consistently, they will be able to hold a pen and write.
Postoperative rehabilitation is extremely important. Parents and children must work together and persist, even if the child resists at times. Long-term consistency is key!
Initial consultation
The incidence of floating thumb is very low, and many people never see it in daily life. But once parents discover similar symptoms in their child, they must not take it lightly, nor be overly anxious. First, bring the child for a timely consultation. If there's a problem, we will face and solve it together!