Treatment of Brachymetatarsia by Distraction Osteogenesis

Abstract

Metatarsal lengthening by distraction osteogenesis was performed on 17 brachymetatarsia patients with 39 metatarsal bones. To lengthen the first metatarsal in an attempt to prevent development of varus deformity of the hindfoot after lengthening, horizontal lengthening in the anterior direction was performed rather than lengthening through the anatomical axis. In addition, care was taken to ensure that the fourth metatarsal bone screw did not interpose with the fifth extensor tendon during the fourth metatarsal lengthening. Lengthening was successful except in 1 case with mean lengthening of 19.5 mm (48.8%) for the first metatarsal and 17.1 mm (36.2%) for the fourth metatarsal. Because of joint stiffness, plantar capsulotomy was performed on 7 cases, 6 of which had been previously operated on bilaterally. Varus deformity of the hindfoot after the first metatarsal lengthening and entrapment of the fifth extensor tendon after the fourth metatarsal lengthening was not detected in any case.

Lengthening of short bones by distraction osteogenesis—results and complications

“…In our study, the healing index was 1.6 months/cm for both metacarpal and metatarsal lengthening. Our healing index for metatarsal lengthening is greater than the healing index reported by other authors [16,19]. We feel that these results are due to a greater amount of lengthening (average lengthening of 24.3 mm) achieved in our study compared with others (average lengthening not less than 17.6 mm) [4,12,17].…”

“…b X-ray taken during distraction osteogenesis using a unilateral fixator. c X-ray after the removal of the frame of more than 2.0 months/cm can be achieved by applying an extension rhythm of 0.75-1 mm/day [11,16]. Many factors have been identified to support a longer consolidation period after distraction osteogenesis.…”

“…The advantages of this method is the achievement of greater final bone length, avoidance of bone grafting, no morbidity at the donor site, suitability for multiple lengthening procedures, shorter delay after metatarsal lengthening before the patient can put weight on the affected limb and a lower incidence of neurovascular damage [4,16,19]. However, when the distraction osteogenesis method is used, some morbidities, such as pin-tract infection, limitation of range of motion, stiffness, subluxation or dislocation of the MTP-MCP joint, angulation and non-union, have been reported [9,17].…”

“…Distraction osteogenesis is currently more popular for bone lengthening [15,16,17]. The advantages of this method is the achievement of greater final bone length, avoidance of bone grafting, no morbidity at the donor site, suitability for multiple lengthening procedures, shorter delay after metatarsal lengthening before the patient can put weight on the affected limb and a lower incidence of neurovascular damage [4,16,19].…”

“…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].…”