This child has a typical type IV bunion. His left thumb is very small, with only a short skin tip connecting the thumb to the palm of the hand, and this skin tip is also very narrow, which makes this child’s bunion very complicated. We performed a semi-metacarpal bone grafting reconstruction (SMRT bunion reconstruction), and after the surgery, the child’s thumb has recovered its shape very satisfactorily, and its function is still quite good. Parents had difficulty in accepting bunionization and wanted to keep all five fingers The parents of the child had been to other doctors before, but given the condition of the child’s hand, the surgical plan given was to suggest that the child should have bunionization when he was older, and the parents had difficulty in accepting that their child would only have four fingers left after the surgery, and they wished to keep all five fingers so that the child’s hand would look complete. So they were looking for a way to save all five fingers until they came to us in the outpatient clinic. This child’s bunion was a very complex case and there were very few options available to us in this case. One of the surgical options for a floating thumb is to cut off the floating thumb and perform a direct bunionization of the thumb, after which the child will only have four fingers forever. The other option is to perform a five-finger surgery, which involves metatarsal bone reconstruction and hemimetacarpal bone grafting. However, the metatarsal bone was not suitable for this child with floating bunion because his soft tissues were too small, so we finally adopted the hemimetacarpal bone graft reconstruction. After the hemi-metacarpal graft reconstruction surgery, the shape of the thumb was restored very satisfactorily After the surgical plan was finalized, we operated on the child for two times, and the whole process of the surgery was relatively smooth. The whole process of the surgery was smooth. After the hemimetacarpal bone graft reconstruction, the soft and bony tissues of the thumb were reconstructed very well, and the mobility and stability of the metacarpophalangeal and carpometacarpophalangeal joints were retained very well. We can now see the whole result after the operation, the shape of the child’s thumb has recovered very well, and the thickness of the thumb after the operation is not the same as the original one. Compared to the preoperative period, the shape of the thumb has improved dramatically. According to the follow-up records, we found that the function of the thumb is also good, his stability is very good, he can grasp large objects, and the situation of grasping small objects is also slowly improving. We hope that he will bring us more surprises when he comes to the clinic for the next review. Floating bunion is a very meaningful way to preserve the five fingers and improve the function and shape of the thumb. We have seen a lot of floating bunions like this one, and we have also done a lot of surgeries like this to preserve the five fingers. Although it is a bit complicated, it is very meaningful for the child to save all five fingers. Cutting off the floating thumb directly and then performing bunionization is relatively simpler for us doctors, but there are a lot of problems from the point of view of the child’s growth, as the four fingers will affect the child’s future study, life, work, social life and other aspects, and some children will have low self-esteem, and many parents have higher requirements for the integrity of their children’s fingers, and it is difficult for them to accept that their children are missing a finger. Many parents have high expectations for the integrity of their children’s fingers and are reluctant to accept their children’s lack of a finger. As this is a lifelong concern, parents must be careful in choosing the right surgical option and surgeon to treat their child’s bunion. Both metatarsal reconstruction and hallux valgus reconstruction can save a child’s five fingers. However, parents prefer to choose hallux valgus reconstruction, which is a more advanced form of bunion surgery, because the surgery is performed only on the child’s hand and does not affect other parts of the body, and there is no need to put a cast on the hand after the surgery, which makes the care of the child much simpler for the parents. Through our follow-up visits over the years, we have found that after we have performed the hemimetacarpal bone graft reconstruction surgery on their children, parents help their children to actively carry out functional exercises, and their children’s thumb function can be restored to about 70% of the time, and they have no problem in grasping large objects, pinching and squeezing small things. Many children’s thumb function and appearance have improved greatly, and their parents are more satisfied.