Every time this child comes for follow-up, the atmosphere in the office is always very lively, from the moment he enters the door of the office, with the phrase “Long time no see, I’m back!” Everyone would always smile because this child had a good recovery after surgery and every time he came for follow-up, he would bring us some surprises, and we had witnessed the whole process of this child’s recovery from pre-operative to post-operative. The child is old, is it still possible to use half metacarpal bone graft for the surgery? A few years ago, this child came to my clinic, and when I took a look, his left thumb belonged to type 3B bunion dysplasia, also known as the floating thumb, which basically had no function. Unlike other children, he was very optimistic and lively, and he even used his floating thumb as a toy to rotate it randomly. According to our recommended age for floating thumb surgery for children, this child was 6 years old at the time, which is slightly on the older side. The parents said that the reason why they had delayed the surgery for so long was because they could not accept the bunionization surgery, and they also had some concerns about the metatarsal reconstruction surgery, until they found out about the semimetacarpal bone grafting reconstruction surgery, and they felt that there was hope. But at the same time, the parents had mixed feelings, although there are new surgical methods, but the child is really not in the ideal age group for surgery. When they came to me, the most common question they asked was whether their child could have a hemi-metacarpal graft reconstruction. After combining their child’s radiographs with a careful examination, I told them unequivocally: yes! Why is it necessary to use hemimetacarpal bone graft reconstruction surgery? From the parents’ point of view, they could not accept that their child would only have four fingers after bunionization. Although the traditional metatarsal bone reconstruction surgery could save the child’s five fingers, the parents thought that their child’s hand had already been injured, and they did not want to move their child’s foot again and make it injured as well. In fact, we have talked about this many times, the floating bunion, we are trying to preserve the integrity of the fingers, none of the five fingers. For the child, if we take half of the metatarsal bone from the child’s foot, whether it’s the second, third or fourth metatarsal, it will affect his walking in the later stages of life, especially in the early stages when he can’t go down to the ground, and if he puts weight on it, it’s easy to cause bending of the remaining half of the metatarsal bone. Once we remove the half metatarsal, the child will be exempted from weight bearing for about three months, but for this age group, exempting the child from weight bearing for three months will have a lot of effects, and it will be very troublesome for the parents to take care of the child, and at the same time the trauma to the child’s foot is unavoidable. So after the parents of this child communicated with us, they decided to use a hemi-metacarpal bone graft, and according to the surgical plan we designed, we did two surgeries for the child, the first one in September 2020 to “move the bone”, and the second one in April 2021 to rebuild the function of the thumb. reconstruction, and the surgeries all went very well. Surgical success is only half the battle, post-surgical functional exercises should not be ignored For some surgeries, it may be enough to pay attention to recuperation and conditioning after the surgery, but for a child with a floating thumb, surgical success is only half the battle, and the other half is the post-surgical functional exercises, which is a very important part of the surgery, and one that is easily ignored by many families, and that’s why I often emphasize the importance of the functional exercises to the parents. Although this child was slightly older when he had the surgery, he was already over 6 years old when he had the surgery, one advantage for this age group is that the child’s compliance is very good, so that the functional exercises for his thumb will be established faster, and with the encouragement and help of the parents, the child will consciously carry out the functional exercises, so the process will be relatively smooth. At the same time, there is another problem, because of the child’s age, his finger shaping ability is not as good as that of younger babies, so in the early stage, we feel that the shape of the child’s finger is not so desirable, but from the perspective of functional priority, we let him keep a partially functioning thumb, and with the functional exercise in the later stage, the function of the thumb is becoming more and more perfect, and it will be more and more important for the child’s life. With later functional exercises, the function of the thumb will become more and more perfect, which will be very helpful to the child’s life and study. Post-operative follow-ups, new surprises every time “Long time no see, I’m back!” “Long time no see, I’m back again!” This is the way this child greeted us every time he came to the outpatient clinic for follow-up. Since their home is not very far from the hospital, he would come for follow-up every once in a while, from the initial thumb could only move in a small range of motion, to be able to do palm-to-palm, grasping movements, to be able to pinch and pinch mung beans, peas and other small things, and to be able to do fine motor movements, and even to write, to draw, to eat with chopsticks, and all of which was done very well, and every time he came to the follow-up we Every time we come for follow-up, we find that the child’s thumb function is getting better and better, which brings us surprises. Of course, the parents have made a lot of efforts to help the child to recover the function, the child’s personality is also very lively and cheerful, the parents are very optimistic, and the guidance is also very good, so the floating bunion does not have too much psychological impact on the child. However, I have higher expectations for the functionality and appearance of this child’s thumb. We will continue to pay attention to the child’s later functional exercises and review, and hope that he will bring us more surprises.