This is an operative fixation of a young patient who was born with a triphalangeal thumb and a rudimentary pre-axial polydactyly. Triphalangeal thumbs are rare cases and we thought that it would make for an interesting case report for submission to POSNA. In this case, the distal portion of the middle phalanx and the proximal portion of the distal phalanx are resected, and a K wire is used to fuse the proximal portion of the middle phalanx and the distal portion of the phalanx in order to create a normal-appearing thumb with 2 phalanges.