Some time ago I met a baby with floating bunions of type IIIC in the outpatient clinic, just one year and two months old, growing relatively well, 12 kilograms, brought by his parents. This is their first baby, there is no precedent of floating bunion in the family and the baby is the only one. They had been to several hospitals before, but had not been able to find a suitable surgical solution. Floating bunion is a rare congenital hand deformity, and many parents have a vague understanding of it. Especially when it comes to the choice of surgery, they don’t know what to do, and are afraid that the wrong choice will delay their child’s life and their future. We understand this feeling very well, and many parents who come to our clinic also have this concern. So what is the best choice for surgery? Our goal is to achieve as much function as possible at a relatively small cost. Surgery is not the goal, improving function is the goal, and this is our approach to treating bunions. There are three main surgical options to treat floating bunions: 1) bunionization, which involves removing the thumb and moving the index finger into the thumb position to be used as a thumb, but the child is left with only four fingers after the surgery. 2) metatarsal reconstruction, which involves removing the thumb from the metatarsal bone. Metatarsal reconstruction, taking part of the metatarsal bone from the foot to reconstruct the first metacarpal bone, is a more traditional surgical plan, with or without vascular graft. It can achieve the purpose of preserving five fingers after surgery, but it will have certain impact on the foot. 3. Semi-metacarpal bone graft reconstruction technique is the main surgical plan we use nowadays for treating floating bunion, taking part of the metacarpal bone from the second metacarpal bone to rebuild the first metacarpal bone, which can achieve the purpose of preserving the five fingers after the operation. The biggest difference between this technique and metatarsal bone graft reconstruction is that one of them needs to take the bone from the foot, while the other one does not. The metacarpal bone is taken from the hand instead, which does not affect the baby’s foot and the donor and recipient areas of the taken bone can continue to grow after the operation. The parents had seen two hospitals before, and the doctors gave the first treatment plan: bunionization of the digits. The parents had some concerns at that time and did not do it, but after learning about the semi-metacarpal bone graft reconstruction technique, the parents brought their child to Wuhan. The parents also raised a concern about their baby’s floating thumb. The parents felt that the baby’s thumb was very different from a normal thumb, which has two bones, but the baby’s thumb has three bones. What’s going on here? What is the extra bone? The extra bone is actually the baby’s metacarpal bone, which is located at the bottom. We generally have long metacarpal bones, but the metacarpal bone of the floating thumb is completely disappeared or only metacarpal bone remains, and the baby’s case belongs to the latter, the metacarpal bone has not completely disappeared completely, and there is still a little bit of remains. In addition to the surgery, the condition of the thumb after the surgery is also a point of concern for parents, what will happen to the thumb after the surgery? What do I need to pay attention to? In the early postoperative period, the baby’s thumb will look bigger, because just after the surgery, the baby’s thumb will have some edema and look bigger. Parents do not need to worry too much as the edema will go down slowly and the thumb will have a better shape after some functional exercises. Functional exercise after thumb surgery is very important and it is done after the two-stage surgery. Semi-metacarpal bone graft reconstruction surgery is divided into two stages, the first stage of the surgery is to move the bone, transplant part of the metacarpal bone to the first metacarpal bone; the second stage of the surgery is to rebuild the function of the thumb, so that the thumb can move. The second stage of surgery is to rebuild the function of the thumb, so that the thumb can move. After the two stages of surgery, functional exercises will be started to build up the function of the thumb step by step, and the process can not be too hasty, and we have to guide the child slowly. Parents can pay attention to what kind of toys their children like in the early stage, and play with these toys in the functional exercise stage, so that the child can slowly realize that the thumb can be moved, and he will like to use the thumb more and more, and the appearance and function of the thumb can be further improved.