The management of brachymetatarsia

Abstract

683 e treated 35 brachymetatarsal rays of 18 feet in 12 patients by one-stage lengthening with interpositional bone grafts or by gradual lengthening with callotasis combined with shortening of the adjacent metatarsals and phalanges. Definition of the two parabolas which connect the metatarsal heads and the tips of the toes, and recognition of three patterns of metatarsal length, were helpful guides in treatment. In total, 36 excisions of the phalanges and/or the metatarsals were undertaken. The mean shortening was 8 mm.The radiological results were satisfactory. The mean values were as follows: one-stage lengthening, length gain, 1.3 cm; healing index, 1.3 months/cm; percentage increase, 30%; gradual lengthening, length gain, 2.0 cm; healing index, 2.0 months/cm; percentage increase, 50%.Associated shortening of an adjacent bone can avoid the disadvantages of one-stage lengthening which may not achieve target length and can result in neurovascular complications. Reduction of the target length enables the surgeon to carry out one-stage instead of gradual lengthening. It also shortens the length of treatment in the group undergoing callotasis and improves cosmesis. J Bone Joint Surg [Br] 2003;85-B:683-90.

Lengthening of short bones by distraction osteogenesis—results and complications

“…The most frequently used technique is either one-stage lengthening with an intercalary bone graft or gradual lengthening by callotasis [2,5,18]. One-stage lengthening of metacarpals has several advantages, including a relatively short union period with less scar tissue formation [2,3,5].…”

“…The most frequently used technique is either one-stage lengthening with an intercalary bone graft or gradual lengthening by callotasis [2,5,18]. One-stage lengthening of metacarpals has several advantages, including a relatively short union period with less scar tissue formation [2,3,5]. However, there are some disadvantages of one-stage lengthening, such as a small gain in length, morbidity of the donor site, neurovascular impairment caused by rapid stretching, graft problems related to multiple lengthening and the limitation of range of motion due to cast immobilisation [2,3].…”

“…Eleven years later, Matev [10] was able to report on his vast experience using this procedure. Further, there have been numerous other practitioners who have reported the specifics of methods that they have employed, either as a one-stage procedure or gradual procedures that lengthen short metatarsals [2,5,16].…”

One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

“…On the dorsoplantar view, a curved line passing through the metatarsophalangeal joints can be drawn. The curve of this line has been defined as the metatarsal parabola, and reportedly has functional importance [14]. In brachymetatarsia, the metatarsal parabola is interrupted near the short metatarsal (Fig.…”

“…Distraction osteogenesis using external fixation systems is a widely used technique to correct congenital brachymetatarsia [1,4,18,28,31]. However, this technique is associated with long duration of treatment, difficulties ensuring maintenance of alignment during distraction, frequent redressing, and patient cooperation [4,14]. Other complications are pain during distraction, pin tract infections, joint stiffness, and premature callus consolidation [5,7,8,17,20,25,32,34,35,38,39].…”