Distraction Osteogenesis for the Shortened Metatarsal After Hallux Valgus Surgery

Hurst, Jason M.; Nunley, James A.

doi:10.3113/fai.2007.0194

Cited by 23 publications

(7 citation statements)

References 16 publications

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“…The advantages of gradual lengthening are the ability to obtain greater length than that using one-stage intercalary bone grafting, immediate weight-bearing and the preservation of movement of the metatarsophalangeal joint. Distraction osteogenesis in small bones in the feet has been reported to be successful following the principles of Ilizarov,2,4,15 but with the disadvantage of regular adjustment of the external fixator, the possibility of insufficient bone formation and the risk of pin-track infection. In order to encourage adequate bone formation, careful osteotomy with the least soft-tissue and vascular damage and a secure external fixator are needed.…”

Section: Discussionmentioning

confidence: 99%

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Lengthening of fourth brachymetatarsia by three different surgical techniques

Lee

Yoo

Moon

2009

The Journal of Bone and Joint Surgery. British volume

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We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p < 0.000). The clinical outcome was compared in the three groups. The mean follow-up was 22 months (7 to 55). At final follow-up, the mean lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p < 0.000). The saw group included eight feet with failure of bone formation after surgery. Additional operations were performed in 20 feet because of stiffness (n = 7, all groups), failure of bone formation (n = 4, saw group), skin maceration (n = 4, bone-graft group), malunion (n = 4, bone-graft and saw groups) and breakage of the external fixator (n = 1, saw group). We conclude that the gradual lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.

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Section: Discussionmentioning

confidence: 99%

“…Brachymetatarsia is a rare congenital deformity which occurs most commonly in the fourth metatarsal. [1][2][3] It can also occur iatrogenically 4,5 or traumatically. 2,6,7 Patients with brachymetatarsia often exclude themselves from social activities because of the appearance of their foot.…”

mentioning

confidence: 99%

Lengthening of fourth brachymetatarsia by three different surgical techniques

Lee

Yoo

Moon

2009

The Journal of Bone and Joint Surgery. British volume

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“…Para estímulo da formação óssea adequada, uma osteotomia cuidadosa deve ser realizada com o mínimo de dano ao tecido mole e vascular. 11,18 No alongamento por distração osteogênica em 2 estágios, a distração é realizada mais rapidamente ($ 2 mm ao dia) e, após alcançado o comprimento desejado, é feita a colocação de enxerto ósseo no regenerado e a substituição da fixação externa pela interna, na ausência de infecção dos pinos, com o objetivo de diminuir o tempo do fixador externo e a rigidez articular. 14 Masada et al 19 relatam maior número de complicações pós-operatórias quando o alongamento realizado é > 40% do comprimento original do metatarso, citando alongamento excessivo, rigidez articular, perda de alinhamento, retardo de consolidação e fratura do regenerado.…”

Section: Discussionunclassified

Tratamento da braquimetatarsia por distração osteogênica com fixador externo monolateral

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Faria

et al. 2021

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Descrever o perfil dos pacientes e os resultados obtidos com o uso de fixador externo para alongamento de metatarso em braquimetatarsia. Métodos Foi realizada uma análise retrospectiva dos prontuários de pacientes com braquimetatarsia tratados entre janeiro de 2018 e abril de 2020. Durante este período, foram operados oito pés de seis pacientes. Foram coletadas e estimadas as frequências em relação a aspectos demográficos e cirúrgicos. Resultados Todas as pacientes (100%; n = 6) eram do sexo feminino, com média de idade de 28 anos, variando de 15 a 48 anos, e motivadas a buscar o serviço de ortopedia em função da deformidade estética. O acometimento era bilateral em duas pacientes e unilateral em quatro pacientes. O tempo médio de alongamento foi de 22 dias ( ± 7,15; intervalo de confiança [IC] 95%: 19,04–26,81). A velocidade de alongamento foi de 0,5 mm/dia e o comprimento médio total do alongamento foi de 11,46 mm ( ± 3,57; IC95%: 9,52–13,40). Metade das pacientes (50%; n = 3) teve infecção local dos pinos e foi tratada com antibióticos; as demais não relataram nenhuma complicação pós-cirúrgica. As pacientes negaram dor ou calosidade após o procedimento cirúrgico e relataram satisfação com os resultados. Conclusão Todas as pacientes eram do sexo feminino e buscaram a cirurgia para braquimetatarsia por motivos estéticos. A distração osteogênica a uma taxa de 0,5 mm/dia resultou em alongamento bem-sucedido do metatarso, com uma baixa frequência de complicações, bons resultados clínicos e alta satisfação das pacientes.

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“…4 To prevent the shortening of the first metatarsal during hallux valgus surgery, opening wedge osteotomy, distraction osteotomy, and intentional depression of the first metatarsal head has been suggested. 5,14 However, we did not attempt to lengthen the first metatarsal or displace the distal metatarsal head in the plantar direction. Nonetheless, there was no significant correlation between the extent of first metatarsal shortening and the occurrence of second metatarsal transfer lesions.…”

Section: Discussionmentioning

confidence: 99%

Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening After Distal Chevron Metatarsal Osteotomy for Hallux Valgus

et al. 2016

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Distraction Osteogenesis for the Shortened Metatarsal After Hallux Valgus Surgery

Abstract: This small series depicts the potential success of distraction osteogenesis for the iatrogenically shortened first metatarsal and associated transfer metatarsalgia.

Cited by 23 publications

References 16 publications

Lengthening of fourth brachymetatarsia by three different surgical techniques

Lengthening of fourth brachymetatarsia by three different surgical techniques

Tratamento da braquimetatarsia por distração osteogênica com fixador externo monolateral

Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening After Distal Chevron Metatarsal Osteotomy for Hallux Valgus

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