Floating thumbs come in all shapes and sizes, have you ever seen a floating thumb like this? Today, we would like to share with you a case of a “special” type of floating thumb, in the hope of attracting your attention. As we can see from the picture, the thumb of this child’s left hand seems to “grow” on top of the index finger, or rather, he seems to “not have” a thumb, but just an extra finger at the lateral edge of the proximal phalangeal joint of the index finger. In fact, this is also a type of “floating thumb”, which belongs to congenital thumb hypoplasia. This is a type of congenital thumb hypoplasia, which undoubtedly requires surgical treatment. Before coming to my clinic, the parents had been taking their children to the major hospitals in Beijing and Shanghai, but most of the replies they received were “cut off the finger”. Cutting off the finger directly means “thumbing”, i.e., moving the index finger to the thumb’s position and using it as a thumb. This is the more traditional surgical option, and it may even seem a bit “crude” because the child will only have four fingers left after the operation. “You’ve got to be kidding me!” This is the first reaction of the parents to this surgical option. I don’t think any parent would be able to accept that their child would only have four fingers. “Doctor, are there other surgical options?” Of course there are! It is entirely possible to preserve five fingers! Currently, there are two main surgical options for the treatment of floating bunions, one is metatarsal bone reconstruction, and the other is hemimetacarpal bone graft reconstruction. The former is to take the metatarsal bone of the foot and transplant it to the thumb, while the latter is to take part of the second metacarpal bone to reconstruct the first metacarpal bone. Both can achieve the goal of preserving the five fingers after surgery. The difference between the two is that the metatarsal bone reconstruction, due to the need to take the bone in the foot, the child’s foot can not be weight-bearing for three months after the operation, which requires at least three months of the foot can not be on the ground; and half metacarpal bone transplantation reconstruction of the bone from the hand, it will not affect the baby’s foot, and at the same time, compared with the former, the transplantation of the bone resorption and necrosis of the probability of will also be greatly reduced. Coming back to the floating bunion in the picture, his specific case was not really manageable with the conventional surgical plan, and after a thorough evaluation, we decided to use the hemi-metacarpal bone graft reconstruction surgery. The surgery involves firstly reconstructing the metacarpal bone, and then reconstructing a complete tiger’s mouth, as well as providing good coverage of all the traumas. All of this is undoubtedly challenging. We designed an individualized surgical plan around the child’s specific situation and successfully completed the first and second stage of the surgery. The child recovered well after the surgery and is now doing functional exercises, and the parents are very satisfied with the overall result. The biggest feeling I got from this case is that I would like to tell parents of children with finger deformities, including floating bunions, firstly, do not give up on your child’s treatment so easily; and secondly, be careful in choosing the right surgical plan for your child. Just like the child in today’s case, the parents have never given up on their child’s treatment, if not for the sake of their child, who would want to run around. In addition, there are better options for children other than bunionization, such as hemi-metacarpal bone graft reconstruction surgery. Although the procedure is very complicated, once the thumb is preserved, all five fingers will be intact, which is very significant for the child. Moreover, the function of the preserved thumb is not worse after the surgery. So, both aesthetically and functionally, preserving all five fingers is more valuable. Parents should not worry when they find that their child has a floating thumb or other finger deformities, as these can be treated with surgery. However, parents need to be more careful in choosing a treatment plan that is suitable for their child and balances aesthetics and function.