One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia

Abstract

Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.

Brachymetatarsia: Surgical Management, Case Report, and Literature Review

“…Some studies have reported the advantages of one stage lengthening [1,[11][12][13]. The advantages of this technique are principally a short treatment period and easier postoperative recovery.…”

“…Some cases reported in the literature did not use a plate and used only k-wire [4,12,14]; in these cases, no complications such as secondary shifting were reported, but these studies concern only small series. Concerning the bone graft, the donor site should be considered; studies reported metatarsal, calcaneal, fibula, and iliac crest bone grafts, and no study compared the benefits of different sites [4,[12][13][14][15].…”

“…The major advantage of callus distraction over one stage bone grafting is that the lengthening of the metatarsal can be increased. In the review of the literature, the mean lengthening of the callus distraction is 18.55 mm (range 15 to 20 mm) and for the one stage procedure is 12.6 mm (range 9.0 to 20.9 mm) [1,2,4,5,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Additionally, the progressive distraction has a second advantage: the simultaneous lengthening of the bone and the soft tissue can avoid the stress caused to the toe.…”