Treatment of Brachymetatarsia by Callus Distraction (Callotasis)

Kawashima, Takao; Yamada, Atsushi; Ueda, Koji; Harii, Kiyonori

doi:10.1097/00000637-199402000-00016

Cited by 55 publications

(42 citation statements)

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“…10 One-stage lengthening with intercalary bone graft may produce morbidity of the donor site, neurovascular impairment caused by rapid stretching, and a small gain in length due to the high tension of surrounding soft tissues. 5,7 We believe that these disadvantages can be overcome by our technique. With callotasis the overall period of treatment, from operation to removal of the external fixator, is between 15 weeks and 4.5 months.…”

Section: Discussionmentioning

confidence: 90%

“…With callotasis the overall period of treatment, from operation to removal of the external fixator, is between 15 weeks and 4.5 months. [4][5][6] In our series, the K-wire was removed on average 8.5 weeks after surgery, and full weight-bearing was usually allowed 12 weeks after operation.…”

Section: Discussionmentioning

confidence: 90%

“…In the 34 cases of metatarsal lengthening, our method led to a mean gain in length of 14 mm, a result similar to that of callotasis, which averaged 13 to 15 mm. 4,6 Excessive lengthening by callotasis may cause subluxation of the metatarsophalangeal joint, 5 although this risk can be minimised by longitudinal K-wire fixation from the distal phalanx to the tarsal bone or metatarsal base of the affected ray (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

“…The most widely-used procedures are either one-stage lengthening with intercalary bone graft [1][2][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.…”

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The treatment of congenital brachymetatarsia by one-stage lengthening

Baek

Chung

1998

The Journal of Bone and Joint Surgery. British volume

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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...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The treatment of congenital brachymetatarsia by one-stage lengthening

Baek

Chung

1998

The Journal of Bone and Joint Surgery. British volume

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“…The total number of studies that met the inclusion criteria was 61. Of the 61 studies, 27 discussed callus distraction (7,, 29 discussed single-stage bone lengthening (1,4,5,11,14,, 3 discussed a combination of the 2 techniques (64-66), and 2 reported on patients who had undergone callus distraction surgery or single-stage lengthening (67,68). These reports were classified into 3 groups according to the procedure: callus distraction, bone grafting, or a combination of the 2.…”

Section: Methodsmentioning

confidence: 99%