The treatment of congenital brachymetatarsia by one-stage lengthening

Abstract

We performed one-stage lengthening using intercalary autogenous bone graft in 34 metatarsals and seven proximal phalanges in 21 patients with congenitally short metatarsals. At operation, in order to decrease the tension in the surrounding soft tissues, we gradually distracted the osteotomies of the affected bones for 20 to 30 minutes. The patients, all women, were followed up for a mean period of 2.1 years (1 to 6.5).The average gain in length for the 34 metatarsal procedures was 14 mm (6 to 21), equivalent to an increase of 32% (11 to 51), and for the seven proximal phalangeal lengthenings 8 mm (5 to 11), an increase of 54% (47 to 65). There was no evidence of neurovascular impairment.The technique of gradual distraction during operation is simple and effective. It overcomes the disadvantages of one-stage lengthening such as a small gain in length and neurovascular damage. Congenital brachymetatarsia describes shortening of the metatarsal bone caused by premature closure of the epiphysis. The fourth toe is most commonly involved, although any or multiple metatarsals may be affected. The deformity has a strong female predilection with a reported sex ratio of 98:4.1 Cosmesis may be a problem, especially in young women. Surgical correction with autogenous bone graft from the calcaneus was first reported in 1969 2 and since then many techniques have been described. The most widely-used procedures are either one-stage lengthening with intercalary bone graft 1-3 or gradual lengthening by callotasis. [4][5][6] Each has its advantages and disadvantages. One-stage lengthening needs a shorter period to bony union and has less morbidity, but produces a proportionally smaller increase and more neurovascular complications than the gradual procedure. 7,8Patients and MethodsBetween 1989 and 1995, we performed 41 one-stage lengthenings (34 metatarsals and seven proximal phalanges) using intercalary autogenous bone graft in 21 patients with congenital brachymetatarsia. To achieve the optimal length of the toe, six proximal phalanges were lengthened with the metatarsal of the same ray. All 21 patients were women and their average age was 16 years (10 to 36). All complained of the appearance of the short toe(s), and ten had occasional pain around adjacent metatarsal heads when walking. In 11 patients the condition was unilateral with the fourth metatarsal involved in ten and the first metatarsal in one. Of the ten patients with bilateral involvement, six showed shortening of the fourth metatarsal, two of the first and fourth metatarsals, one of the first, third and fourth metatarsals, and one of the fourth metatarsal and adjacent proximal phalanx. In 19 patients, we used intercalary autogenous iliac-bone grafts (Figs 1 and 2). In two patients with bilateral short first and fourth metatarsals, the second and third metatarsals were shortened and the excised bone used to lengthen the fourth metatarsal (Fig. 3). There was a family history in three patients. Four patients had associated brachymetacarpia which was bilateral in two and...

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].…”

“…The presence of short metacarpals does not impair hand function and surgical intervention is performed primarily for cosmetic reasons [4,20]. However, patients with short metatarsals often suffer from unacceptable cosmesis, plantar pain, callosities on the heads of the metatarsals, difficulty in wearing shoes and in walking due to the cockup deformity [2,17]. Mansoor [8] was the first to introduce a technique that allows for metacarpal lengthening.…”

“…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

“…Brachymetatarsia is defined as an abnormal shortness of a metatarsal bone [2,15]. It is a rare deformity, the incidence of which is reported as ranging from 0.02% to 0.05% [28,29], with a clear female preponderance of 25:1 [28].…”