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Li X, Gu J, Wu Y, Wang Y, Gong X, Sun N, Li Y, Lai L, Li W, Li H, Yang X, He X, Du H. Treatment of Fourth Metatarsal Brachymetatarsia Using Distraction Osteogenesis with External Fixator: Surgical Techniques, Outcomes and Complications. Orthop Surg 2024. [PMID: 39187992 DOI: 10.1111/os.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE Surgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia. METHODS A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16-31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t-student test for pre- and postoperative AOFAS MTP-IP scores. RESULTS Patients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = -10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes. CONCLUSION Metatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.
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Affiliation(s)
- Xing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jianming Gu
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Gong
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Ning Sun
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Liangpeng Lai
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wenjing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Heng Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaosong Yang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaotian He
- Department of Foot and Ankle Surgery, Beijing Da Wang Lu Emergency Hospital, Beijing, China
| | - Hui Du
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Jagani N, Fagir M, Dalal N, James LA. Metatarsal lengthening by distraction osteogenesis for brachymetatarsia in paediatric patients: is it safe and effective? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1839-1844. [PMID: 38427053 DOI: 10.1007/s00590-024-03860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The primary aim is to assess the efficacy of the surgical callus distraction technique of the metatarsus in paediatric patients. Secondary objectives are to assess complications and treatment duration. We have also described the details of our surgical technique. MATERIALS AND METHODS A case series review of paediatric patients who had metatarsal lengthening at our unit between 2014 and 2022. Patient demographics, duration of time in frame, complications and metatarsal length achieved were recorded. The AOFAS Midfoot and the MOXFQ were taken pre-operatively and at final follow-up. RESULTS Sixteen metatarsals in 8 patients (14 feet) underwent lengthening between 2014 and 2022 using the MiniRail OrthoFix 100 (Orthofix Medical Inc, Lewisville, TX, USA). The mean age was 13.3 (12-17) years. The average duration between surgery and implant removal was 5.2 months. According to Paley's classification, there was one obstacle encountered in a patient who required a revision of their osteotomy and one problem in another patient who had an infected metatarsophalangeal joint stabilising k-wire treated with oral antibiotics. The Mean AOFAS Midfoot score improved from 53.10 to 86.40 (p < 0.0001) and the Mean MOXFQ improved from 32.5000 to 12.1250 (p < 0.05); these were statistically significant. CONCLUSION Gradual metatarsal lengthening using the MiniRail external fixator is a safe and effective method to treat brachymetatarsia in paediatric patients. This preliminary report describes and supports metatarsal lengthening in appropriate patients. Holistic care in terms of a pre-operative assessment, psychological support and preparation for the extended rehabilitation period are vital.
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Affiliation(s)
| | | | - Neel Dalal
- Alder Hey Children's Hospital, Liverpool, UK
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Sepulveda M, Orellana G, Sanchez F, Birrer E. Brachymetatarsia. EFORT Open Rev 2024; 9:235-240. [PMID: 38579763 PMCID: PMC11044089 DOI: 10.1530/eor-23-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Brachymetatarsia involves a reduction in length of one or more metatarsals. The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola. In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia. A possible association with genetic disorders needs to be investigated during clinical evaluation. Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.
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Affiliation(s)
- Matías Sepulveda
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
- AO Foundation, LEGEC Expert Group, Davos, Switzerland
| | - Gabriel Orellana
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
| | - Francisco Sanchez
- Clínica Puerto Varas, Puerto Varas, Chile
- Clínica Puerto Montt, Puerto Montt, Chile
| | - Estefania Birrer
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
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Siddiqui NA, Mateen S, Thomas MA, Millonig KJ. Comparing Outcomes of Acute Versus Gradual Surgical Correction in Brachymetatarsia. J Foot Ankle Surg 2024; 63:281-285. [PMID: 38061623 DOI: 10.1053/j.jfas.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023]
Abstract
Brachymetatarsia consists of a shortened metatarsal resulting in a shorter toe. Pain with shoe wear and cosmetic concerns are the main reasons for surgical intervention. Surgical techniques to increase metatarsal length include acute lengthening with interpositional bone grafting or gradual lengthening with callus distraction. We performed a retrospective cohort study for 1 surgeon's patients at 1 institution over 10 years. Twenty-nine feet in 22 patients met inclusion criteria for acute correction; 16 feet in 11 patients were included for gradual correction. Mean ages were 26.3 ± 12.1 and 27 ± 10.8 in the acute and gradual groups, respectively (p = .79). Most patients were female: 95.4% of acute cases and 90.1% of gradual cases. Most involved lengthening the fourth metatarsal: 86.7% and 100% of acute and gradual groups, respectively (p = .54). Correction obtained amounted to 14.4 ± 2.97 mm (range, 10-22 mm) in acute cases and 14.8 ± 2.39 mm (range, 10-20 mm) in gradual cases (p = .81). The mean percent increase in metatarsal length was 21.1 ± 14% for acute and 22.6 ± 12.4% for gradual (p = .72). Mean consolidation was 8.9 ± 2.51 weeks for acute and 21.4 ± 10.8 weeks for gradual (p = <.001). Nonunions were most common in the gradual group (37.5%) with need for more revisional surgery (43.5%) compared with the acute group; both were statistically significant. We conclude that acute brachymetatarsia correction can obtain correction similar to the gradual technique with fewer postoperative complications and less osseous consolidation time.
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Affiliation(s)
- Noman A Siddiqui
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Sara Mateen
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Michael A Thomas
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Kelsey J Millonig
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
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Ossama HM, Kholeif S, Elhady GM. The Use of Fluorescence In situ Hybridisation in the Diagnosis of Hidden Mosaicism in Egyptian Patients with Turner Syndrome. J Hum Reprod Sci 2023; 16:286-298. [PMID: 38322635 PMCID: PMC10841934 DOI: 10.4103/jhrs.jhrs_128_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
Background Turner syndrome (TS) is the most common chromosomal abnormality in females. The diagnosis of TS is based on karyotyping of 30 blood lymphocytes. This technique does not rule out tissue mosaicism or low-grade mosaicism in the blood. Because of the associated risk of gonadoblastoma, mosaicism is especially important in case this involves a Y chromosome. Aims This study was set to determine the value of additional genetic studies such as fluorescent in situ hybridisation and the inclusion of buccal cells in search for mosaicism in TS patients. Settings and Design This cross-sectional, descriptive study was performed in Human Genetics Department, Medical Research Institute, Alexandria University. Materials and Methods Fluorescence in situ hybridisation technique was applied to lymphocyte cultures as well as buccal smears using centromeric probes for X and Y chromosomes. Genotype phenotype correlation was also evaluated. Statistical Analysis Used Descriptive study where categorical variables were described using number and percentage and continuous variables were described using mean and standard deviation. Results Fluorescence in situ hybridisation technique study detected hidden mosaicism in 60% of studied patients; 20% of patients had a cell line containing Y material, while 40% had variable degrees of X, XX mosaicism, and in the remaining 40% no second cell line was detected. Fluorescence in situ hybridisation study helped identify the origin of the marker to be Y in all patients. The introduction of an additional cell line helped in identifying mosaicism in patients with monosomy X. Virilisation signs were only observed among TS patients with Y cell line mosaicism. The clinical manifestations were more severe in patients with monosomy X than other mosaic cases. Conclusions Molecular cytogenetic investigation for all suspected cases of TS should be considered for appropriate treatment plan and genetic counselling.
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Affiliation(s)
- Heba Mohamed Ossama
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Soha Kholeif
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ghada Mohamed Elhady
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Hung WC, Chen CH, Lin CH, Chen TY, Lo SP. Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review. Foot Ankle Surg 2023; 29:86-89. [PMID: 36328920 DOI: 10.1016/j.fas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. METHODS Four feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, and any complications were recorded. RESULTS The patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6-28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1-18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7-41.1 %). The mean AOFAS score (0-100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1-11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. CONCLUSION Subacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.
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Affiliation(s)
- Wei-Chen Hung
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chun-Ho Chen
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Tzu-Yin Chen
- Department of Physical Therapy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Sheng-Pin Lo
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
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Thomas MA, Siddiqui NA, Millonig KJ, Siddiqui Y, Charles C, Khan BM. The Role of the Shortened Proximal Phalanx in the Setting of Brachymetatarsia. J Foot Ankle Surg 2022; 62:129-131. [PMID: 35853807 DOI: 10.1053/j.jfas.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
Brachymetatarsia is a condition in which a metatarsal bone does not grow out to full length. This is caused by premature physeal closure. The proximal phalanx associated with the shortened metatarsal helps achieve the natural parabola of the foot. A hypoplastic proximal phalanx is a common finding in patients with brachymetatarsia. The goal of this study was to determine the length of the proximal phalanx in the setting of brachymetatarsia, and how much the shortening is attributed to the clinically smaller toe. We performed a retrospective study to evaluate the length of the proximal phalanx in the shortened ray. After the metatarsal was brought out to the desired length of correction, the proximal phalanx was measured on radiographs. Ninety-seven feet with congenital brachymetatarsia were reviewed in a cohort of 66 patients who underwent surgical correction between January 2005 and February 2020 at a single institution. The group was comprised of 61 females and 5 males, with a mean age of 27.5 years. The average length of the proximal phalanx associated with the affected metatarsal was noted to be 18.9 ± 3.83 mm for males and 15.6 ± 4.02 mm for females. Our results indicate the shortened proximal phalanx is 5 mm shorter when compared to normal population and is a contributing factor to the shortened clinical appearance of the digit in brachymetatarsia. Treating surgeons should be aware of this to better educate patients on the influence of the digit on the overall shortening seen in cases of brachymetatarsia.
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Affiliation(s)
- Michael A Thomas
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Noman A Siddiqui
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Kelsey J Millonig
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Yumna Siddiqui
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Cassandre Charles
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Bilal M Khan
- International Center for Limb Lengthening, Rubin Institute of Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
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Toporowski G, Thiesen R, Gosheger G, Roedl R, Frommer A, Laufer A, Rölfing JD, Vogt B. Callus distraction for brachymetatarsia - A comparison between an internal device and the external fixator. Foot Ankle Surg 2022; 28:1220-1228. [PMID: 35525786 DOI: 10.1016/j.fas.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/15/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Symptomatic patients with severe brachymetatarsia are commonly treated with callus distraction using external mini-fixator (EF) or internal device (ID). This study points out advantages and limitations of both methods comparing clinical and radiographical parameters. METHODS Retrospective analysis of 21 metatarsal bones in twelve patients. Twelve metatarsals were treated with ID (Genos Mini), nine with EF (MiniRail). RESULTS Mean lengthening distance was 17.3 mm using EF and 11.7 mm using ID (p = 0.016). Adverse results were observed in 89% of metatarsals treated with EF and in 33% treated with ID (p = 0.011). Postoperative surgical intervention was required in 33% using EF compared to 0% using ID (p = 0.031). Mean total German Foot Function Index (FFI-T) improved from 49 to 33 using EF and from 47 to 22 using ID (p < 0.001). CONCLUSION CD is a reliable surgical treatment for BMT. Surgeons should be aware of implant-related advantages and complications when counseling patients about treatment options.
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Affiliation(s)
- Gregor Toporowski
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Roman Thiesen
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Robert Roedl
- Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Adrien Frommer
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Andrea Laufer
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Duedal Rölfing
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
| | - Bjoern Vogt
- Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Marwan Y, Dalu KA, Bernstein M, Hamdy RC. Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System. Strategies Trauma Limb Reconstr 2022; 17:184-188. [PMID: 36756291 PMCID: PMC9886031 DOI: 10.5005/jp-journals-10080-1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Abstract
Aim To describe the surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System (Orthofix Medical Inc., Lewisville, TX, USA). Background Brachymetatarsia refers to the shortening of the metatarsal bone. When indicated, metatarsal lengthening is performed to treat this deformity. Technique A dorsal approach to the short metatarsal is performed, protecting the neurovascular structures and the extensor tendons. The most proximal wire or screw is inserted first, followed by the most distal wire or screw. The distal wire or screw should not be inserted in the metatarsal head. The middle wires or screws are inserted thereafter. All wires or screws should be placed perpendicular to the anatomic axis of the bone. Once the MiniRail lengthener is assembled, a 1.6 mm K-wire is inserted from the tip of the toe into the metatarsal head, blocking the motion of the metatarsophalangeal joint and avoiding joint subluxation during lengthening. The osteotomy is then performed perpendicular to the metatarsal shaft, in between the middle two wires and screws. Conclusion The surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System was described in detail with accompanying step-by-step intraoperative clinical and fluoroscopic images. Clinical significance This surgical technique of metatarsal lengthening is simple and effective. An understanding of the surgical technique of gradual lengthening of the metatarsal bone is important when treating shorting deformities of more than 1 cm. How to cite this article Marwan Y, Abu Dalu K, Bernstein M, et al. Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System. Strategies Trauma Limb Reconstr 2022;17(3):184-188.
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Affiliation(s)
- Yousef Marwan
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khaled Abu Dalu
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie C Hamdy
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Brachymetatarsia: Surgical Management, Case Report, and Literature Review. Case Rep Orthop 2022; 2022:8253096. [PMID: 35310144 PMCID: PMC8930250 DOI: 10.1155/2022/8253096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Brachymetatarsia is defined by an abnormal shortening of the metatarsal bone. This rare condition is mostly primary and congenital. Consequences of this malformation are both esthetic and functional, due to pain and mechanical problems in the forefoot. Surgical management is an important part of patient care. There are two main options: gradual lengthening by progressive callotosis distraction using an external fixator and one stage lengthening using bone graft and osteotomy of the bone. This review presents two cases using the one stage lengthening surgical management method. We also discuss some reports in the literature with the aim to compare the advantages and disadvantages of the two surgical methods. Literature concerning the surgical management of brachymetatarsia was identified using the PubMed and Google Scholar databases. Patient Presentation. We describe two female patients aged 20 and 26 years who underwent one stage lengthening surgery of the fourth toe with isolated brachymetatarsia using an iliac bone graft and internal fixator plate. The two patients had a lengthening of around 10 mm after postoperative evaluation. No skin complications were noted, but one of the patients reported flexor stiffness after surgery. Concerning the functional and cosmetic aspects, the two patients are satisfied with the management. Conclusions In the literature, one stage lengthening seems to be the most favorable option for the care of brachymetatarsia. Studies show a short healing time and fewer complications like infection, stiffness, malalignment, and malunion. Some reviews note the utility of the gradual lengthening of severe brachymetatarsia when a longer lengthening is necessary. There is no definite consensus concerning the management of brachymetatarsia.
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Chaparro F, Espinoza R, Pellegrini MJ, Carcuro G, Ortiz C. One-Stage Lengthening and Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Brachymetatarsia. Foot Ankle Int 2022; 43:274-279. [PMID: 34558339 DOI: 10.1177/10711007211039526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Felipe Chaparro
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Raul Espinoza
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Manuel J Pellegrini
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Giovanni Carcuro
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Cristian Ortiz
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
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Abstract
This article describes the 3 main surgical options for correction of congenital brachymetatarsia in childhood. The one-stage lengthening by lengthening osteotomy and lengthening with graft interposition are suitable for defects less than 10 mm. For the greater defects from 10 mm to more than 20 mm, gradual lengthening by callus distraction with an external or internal fixator is appropriate. Over the last years, callus distraction with an internal minifixator became commonly established because of the significantly improved aftercare with early full weight-bearing and high postoperative comfort for the child. All 3 surgical procedures are presented with comprehensive image material.
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Affiliation(s)
- Hubert O Klauser
- HAND- UND FUSSZENTRUM BERLIN, Schlüterstr. 38, Berlin 10629, Germany.
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13
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Zhang N, Xu H, Huang Z, Wang Y, Li Z, Xu W, Hu Y. Plantar approach for treatment of brachymetatarsia: A novel approach with an aesthetic consideration. J Plast Reconstr Aesthet Surg 2021; 75:1668-1673. [PMID: 34975001 DOI: 10.1016/j.bjps.2021.11.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/04/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
In the past, open osteotomy was always performed through a dorsal approach in the surgical treatment of brachymetatarsia, which created scar formation on the dorsal skin, subsequently resulting in dissatisfaction with cosmetic results. In this study, we provided a plantar approach to avoid forming scars on the dorsal side. A retrospective review was conducted in nine patients (13 feet) with brachymetatarsia treated with an open osteotomy and gradual bone lengthening through a plantar approach. Visual analogue scale (VAS) was used to evaluate the satisfaction of foot appearance, and we designed a questionnaire called appearance index (AI) to assess the influence of foot appearance on quality of life after surgery. The complications were also recorded during the follow-up. The patients were followed up for 34.8 ± 23.7 months. All cases were healed with a time of 64.4 ± 7.1 days and a healing index of 44.1 ± 7.8 d/cm. Satisfaction VAS for foot appearance improved from a preoperative score of 1.7 ± 1.3 points to a postoperative score of 9.3 ± 0.5 points. The AI improved from a preoperative score of 9.2 ± 0.8 points to a postoperative score of 0.6 ± 0.7 points. Complications were observed in three feet (23.1%), but none was related to the plantar approach. In conclusion, the plantar approach for metatarsal osteotomy and pins fixation was a safe and efficient technique with a satisfactory cosmetic result for the patients. No complications related to the novel approach, such as neurovascular injury, were reported.
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Affiliation(s)
- Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Hua Xu
- Linyi Cancer Hospital, Linyi, PR China
| | - Zheng Huang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Yang Wang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Zhengxun Li
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Wenpeng Xu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Yong Hu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China.
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14
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Tratamento da braquimetatarsia por distração osteogênica com fixador externo monolateral. Rev Bras Ortop 2021; 57:75-81. [PMID: 35198112 PMCID: PMC8856843 DOI: 10.1055/s-0041-1735828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective
To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia.
Methods
A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects.
Results
All patients (100%;
n
= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04–26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52–13.40). Half of the patients (50%;
n
= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results.
Conclusion
All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.
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15
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Matsubara S, Onodera T, Iwasaki K, Hishimura R, Matsuoka M, Kondo E, Iwasaki N. Hallux Valgus With Second Brachymetatarsia Discovered Accidentally: A Case Report. J Foot Ankle Surg 2021; 60:1060-1062. [PMID: 33836969 DOI: 10.1053/j.jfas.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023]
Abstract
Hallux valgus deformity is one of the most common foot and ankle diseases, while brachymetatarsia is a rare foot anomaly with pathological shortening of a metatarsal bone. We present a case of hallux valgus deformity possibly due to second brachymetatarsia. As the hallux valgus was associated with dorsal dislocation of the second toe that made it difficult to evaluate the length of the second toe, the patient was unaware of the second metatarsal shortening until the lengths of the toes compared by manual reposition of the second MTP joint. In this case, proximal osteotomy of the first metatarsal on the hallux valgus and single-stage bone lengthening of the second metatarsal with iliac bone grafting on the second brachymetatarsia were performed. One year after the operation, the callosity of the third toe resolved and the clinical scores were improved. In the case of a hallux valgus deformity with second dorsal dislocation of the toes, surgeons should consider that there are rare cases with second metatarsal shortening. When hallux valgus associated with second brachymetatarsia is diagnosed, second metatarsal lengthening should be considered in addition to hallux valgus surgery.
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Affiliation(s)
- Shinji Matsubara
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Senior Lecturer, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Koji Iwasaki
- Orthopaedic Surgeon, Department of Functional Reconstruction for the Knee Joint, Sapporo, Japan
| | - Ryosuke Hishimura
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Professor, Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Professor, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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16
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Fusini F, Alessandro M, Rava A, Kristijan Z, Felli L, Colò G. Aetiology, diagnosis, and treatment of brachymetatarsia: a narrative review. Musculoskelet Surg 2021; 106:99-109. [PMID: 34268706 DOI: 10.1007/s12306-021-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Brachymetatarsia (BM), or hypoplastic metatarsal, is an abnormal shortening of one or more metatarsal bones with a female-to-male ratio of 10.53:1. Different causes are described in the literature, such as congenital, acquired, or iatrogenic, associated with different conditions and syndromes. Its presence may develop deformity and pain; however, often feet are pain free and the major worries of patients are cosmetics. Non-operative treatments aim to improve the comfort of metatarsal heads and the possible dorsal conflict through comfortable shoes or the use of specific orthotics. The surgical treatment is anything but straightforward, with "one-stage" or "two stage" techniques, the latter better called "by gradual distraction". One-stage procedures are more rapid techniques but have limited ability to restore the desired length due to neurovascular compromise caused by acute lengthening. Insufficient correction is also possible. On the contrary, by gradual distraction procedures allow gradual distraction lengthening of more than 1.5 cm, but require the use of an external fixator, with a higher risk of complications in more than about 50% of surgeries. The adjacent metatarsal shortening should be considered in combination with other techniques, to diminish the excessive lengthening. In each case, surgeries should be always decided on each patient's concerns, deformities, and clinical needs.
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Affiliation(s)
- F Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084, Mondovì, CN, Italy
| | - M Alessandro
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - A Rava
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - Z Kristijan
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
| | - L Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - G Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
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17
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Barik S, Farr S. Brachymetacarpia and brachymetatarsia: do we need to operate? EFORT Open Rev 2021; 6:15-23. [PMID: 33532083 PMCID: PMC7845563 DOI: 10.1302/2058-5241.6.200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Brachymetacarpia and brachymetatarsia are rare congenital presentations denoted by shortening of metacarpals and metatarsals respectively, in which the deformity usually presents around childhood/early adolescence. The aetiology is usually congenital besides several other syndromic or endocrinologic associations. Cosmetic issues such as absence of a normal-looking knuckle while making a fist or disruption of finger-tip curvature besides functional issues are the main indications for surgical intervention in brachymetacarpia. In the foot, apart from cosmetic issues, pain due to transfer metatarsalgia as well as callosities along with toe deformities which lead to difficulty of using footwear are the main indications for intervention. Lengthening of the affected bone, either acute with grafting or gradual, is the mainstay of treatment. Gradual lengthening can be either single-stage as in callotasis, or two-stage where the primary procedure is followed by bone grafting after the length has been achieved. Adolescence, specifically between 12 and 15 years, is the preferred period for surgical intervention in these cases.
Cite this article: EFORT Open Rev 2021;6:15-23. DOI: 10.1302/2058-5241.6.200087
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Affiliation(s)
- Sitanshu Barik
- Pediatric Orthopedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sebastian Farr
- Orthopedic Hospital Speising, Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Vienna, Austria
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18
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Fuiano M, Mosca M, Caravelli S, Di Liddo M, Grassi A, Majumdar A, Massimi S, Catanese G, Zaffagnini S. Callus distraction with external fixator for the treatment of congenital brachymetatarsia of the fourth ray. Foot Ankle Surg 2020; 26:693-698. [PMID: 31540836 DOI: 10.1016/j.fas.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 07/07/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Brachymetatarsia is a rare abnormality of the foot which occurs most frequently in the first and fourth metatarsals. The aim of this study was to evaluate the efficacy of gradual metatarsal lengthening by external fixator for treatment of brachymetatarsia of the fourth ray. The hypothesis was that with external fixation it would be possible to achieve the desired length of the metatarsal with a low rate of complications. Secondarily, in cases requiring a greater amount of correction, it was hypothesized that an opportune rate of bone consolidation would be achievable using a traditional oscillating saw without predrilling or use of a cold osteotome. METHODS Between 2013 and 2016, 12 eligible patients and 13 feet underwent gradual metatarsal lengthening by an external fixator (MiniRail System M103, Orthofix) due to brachymetatarsia of the fourth ray. Mean age at surgery was 24.5±5.3 years (range 19-36), with mean follow-up of 22.3±8.3 months. Clinical evaluation was performed with the AOFAS lesser metatarsophalangeal-interphalangeal (MTP-IP) score. Radiographic assessment was performed on follow-up using non-weightbearing dorsoplantar foot radiographs. RESULTS The mean AOFAS lesser MTP-IP score improved from a preoperative score of 76.6±7.1 points (range 62-85 points) to a postoperative score of 90.3±3.0 points (range 86-95 points). The average amount of lengthening was 16.8±3.9mm (range 8-22mm). Mean shortening, final lengthening, Healing Index, period of treatment, and complications are also reported. The operative technique is described. CONCLUSIONS Gradual metatarsal lengthening with external fixator is an effective treatment for brachymetatarsia and can restore forefoot anatomy with good clinical outcomes, a low rate of morbidity and complications in selected cases. Particular attention should be given when treating patients with shortening >20mm.
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Affiliation(s)
- Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Michele Di Liddo
- Chirurgia Protesica di Anca e Ginocchio, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aditi Majumdar
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131-0001, United States
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Catanese
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Qin B, Wu S, Xie H, Huang F, Zhang H. [Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:168-172. [PMID: 32030946 DOI: 10.7507/1002-1892.201907063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect. Methods Between July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7. Results The incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences ( t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000). Conclusion Lesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.
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Affiliation(s)
- Boquan Qin
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Shizhou Wu
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hui Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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20
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Abstract
Brachymetatarsia is a rare deformity with controversial clinical presentation. Multiple acute and gradual lengthening surgical techniques have been described for correction of this type of foot deformity. All techniques try to create a better appearance, facilitate shoeing, or solve possible transfer metatarsalgia. Either acute lengthening (1-stage procedure) or gradual lengthening (2 stages) is selected based on the patient's deformities, concerns, and clinical needs.
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21
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Özdemir M, Kavak RP, Akdağ T. A rare case of isolated congenital unilateral brachymetatarsia presenting in a young adult male. Radiol Case Rep 2019; 14:1252-1254. [PMID: 31462949 PMCID: PMC6706637 DOI: 10.1016/j.radcr.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/09/2022] Open
Abstract
Congenital brachymetatarsia is a rare skeletal anomaly which is characterized by the abnormal length reduction of one or more metatarsal bones. It occurs as the result of the early closure of the growth plate. While the majority of the reported cases are idiopathic, it can also be seen in association with various genetic conditions or syndromes. Brachymetatarsia most commonly involves the fourth metatarsal followed by the first metatarsal. This rare disorder is mostly bilateral and reported almost exclusively in females. Herein, we present a rare case of congenital unilateral brachymetatarsia which was incidentally detected in a young adult male.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Rasime Pelin Kavak
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Tuba Akdağ
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
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22
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Waizy H, Polzer H, Schikora N, Forth A, Becker F, Stukenborg-Colsman C, Yao D. One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia. Foot Ankle Spec 2019; 12:330-335. [PMID: 30280593 DOI: 10.1177/1938640018803731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Hazibullah Waizy
- Hessing Stiftung, Augsburg, Germany.,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | | | | | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Daiwei Yao
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
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23
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Abstract
Brachymetatarsia is a malformation characterized by an abnormal reduction in the length of 1 or more metatarsal bones. It occurs because of early closure of the growth plate of the affected metatarsal. Generally, it is caused by a congenital disorder and it usually occurs bilaterally. With a greater prevalence in females, it most often affects the fourth metatarsal, followed by the first metatarsal. Surgical treatments proposed include using external mini-fixators or bone grafts in a single step to lengthen the metatarsal. In this review, 62 scientific articles about brachymetatarsia were analyzed with key demographic and epidemiological aspects of this pathology. The prevalence of bilateral brachymetatarsia was 47%, and the female to male ratio was 10.53:1. Both these findings appear to contradict the usual data reported for brachymetatarsia. A better understanding of this disorder will enable an appropriate therapeutic approach according to the psychological and social profile of affected individuals.
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24
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Peña-Martínez VM, Palacios-Barajas D, Blanco-Rivera JC, Arnaud-Franco Á, Elizondo-Rodríguez JA, Acosta-Olivo C, Vílchez-Cavazos F, Morales-Avalos R. Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia. Foot Ankle Int 2018; 39:942-948. [PMID: 29641262 DOI: 10.1177/1071100718770388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. METHODS A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. RESULTS The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. CONCLUSION Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Víctor Manuel Peña-Martínez
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Dionisio Palacios-Barajas
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Juan Carlos Blanco-Rivera
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Ángel Arnaud-Franco
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Jorge Alberto Elizondo-Rodríguez
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Carlos Acosta-Olivo
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Félix Vílchez-Cavazos
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Rodolfo Morales-Avalos
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
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Woo SH, Bang CY, Ahn HC, Kim SJ, Choi JY. Anatomical reconstruction of the fourth brachymetatarsia with one-stage iliac bone and cartilage cap grafting. J Plast Reconstr Aesthet Surg 2017; 70:666-672. [DOI: 10.1016/j.bjps.2017.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/25/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
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Froehlich V, Wuenschel M. A rare combination of brachymetatarsia and congenital hallux varus: case report and review of the literature. J Am Podiatr Med Assoc 2016; 104:85-9. [PMID: 24504582 DOI: 10.7547/0003-0538-104.1.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hallux varus is defined as a medial deviation of the phalanx at the first metatarsophalangeal joint and can be congenital or acquired. Brachymetatarsia is defined as shortening of the metatarsal bones. A combination of hallux varus and brachymetatarsia is rare. A 15-year-old girl presented to our outpatient clinic complaining of problems with her feet. A distinctive hallux varus was present bilaterally combined with a brachymetatarsia of the first metatarsals. The patient reported discomfort. She was restricted in her activities and had severe psychological strain owing to the deformity. We decided on surgery. First, a Pennig MiniFixator for callus distraction of the first metatarsal bone was applied. Owing to the increased plantar subluxation of the phalanx during distraction, an extension of the external fixator was administered so that the hallux could be repositioned to a physiologically satisfying position. After sufficient callus formation, the hardware was removed 14 weeks after surgery. Thereafter, the phalanx moved back to the subluxed position. Finally, an arthrodesis of the first metatarsophalangeal joint was performed with a locking plate. Surgery should not be made only for cosmesis and associated psychological aspects; but, discomfort should be the deciding factor. The postoperative clinical and cosmetic results in our case were good, and the patient was quite satisfied. There was no longer any preoperative discomfort and pain.
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Affiliation(s)
- Vanessa Froehlich
- Department of Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
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Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience. J Pediatr Orthop 2016; 36:582-8. [PMID: 25929771 DOI: 10.1097/bpo.0000000000000503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome. METHODS This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated. RESULTS Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%). CONCLUSIONS Anatomic features of Apert foot may lead to complaints that may limit patients' daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nancy Formosa
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
| | - Mark Buttigieg
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
| | - John Torpiano
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
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Barbier D, Neretin A, Journeau P, Popkov D. Gradual Metatarsal Lengthening by External Fixation: A New Classification of Complications and a Stable Technique to Minimize Severe Complications. Foot Ankle Int 2015; 36:1369-77. [PMID: 26163560 DOI: 10.1177/1071100715593373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The surgical management of brachymetatarsia remains controversial, and choice is based on potential complications. We report a classification of complications based on severity, and we hypothesized that use of a semicircular external fixator would minimize severe complications in lateral metatarsal lengthening. METHODS We retrospectively reviewed 30 patients (10 to 46 years old) with single or multiple brachymetatarsia and performed 54 metatarsal lengthenings with a mean follow-up of 7 months. RESULTS The mean gain in length was 15 mm (33.7%), and the mean healing index was 67 d/cm. No further procedure was performed. No dislocations or subluxations were reported, but 26 complications (48.1%) occurred, classified as 1 severe (1.8% of the metatarsals), 5 intermediate (9.3%), and 20 benign (37%): 4 incomplete osteotomies, 8 adjacent metatarsal osteotomies, 2 involuntary adjacent metatarsal fixations due to the lack of fluoroscopy use, 6 early consolidations, 2 metatarsal fractures, 2 skin complications, 1 superficial infection, and 1 metatarsophalangeal clinodactyly. CONCLUSION A classification of complications based on severity was developed. Gradual lengthening of the lateral metatarsals by semicircular external fixation reduced the risk of severe complications because of stability without donor site morbidity. Thin wires were an advantage in the pediatric population. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Dominique Barbier
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia Service d'orthopédie pédiatrique, Hôpital des Enfants, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Andrei Neretin
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Pierre Journeau
- Service d'orthopédie pédiatrique, Hôpital des Enfants, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Dimitry Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia
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Jones MD, Pinegar DM, Rincker SA. Callus Distraction Versus Single-Stage Lengthening With Bone Graft for Treatment of Brachymetatarsia: A Systematic Review. J Foot Ankle Surg 2015; 54:927-31. [PMID: 25998479 DOI: 10.1053/j.jfas.2015.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Indexed: 02/03/2023]
Abstract
Brachymetatarsia deformity is a cosmetically displeasing anomaly that can become physically symptomatic. The surgical techniques most commonly used to repair the anomaly include single-stage lengthening with a bone graft, callus distraction, or a combination of bone grafting and callus distraction. A systematic review of the published data was performed to compare the outcomes of these 3 surgical procedures. A total of 61 studies reporting the use of callus distraction or single-stage lengthening, or both, for the treatment of brachymetatarsia were included in the present review. The incidence of major postoperative complications after callus distraction, single-stage lengthening, and the combination procedure was 49 (12.62%), 13 (3.72%), and 3 (33.33%), respectively. The number of minor complications with callus distraction, single-stage lengthening, and the combination procedure was 152 (39.18%), 55 (15.76%), and 1 (11.11%); the mean percentage of the original length achieved was 37.36%, 25.98% and 36.00%; and the mean length achieved was 17.5, 13.2, and 14.0 mm, respectively. The healing index (mo/cm) and healing time was 2.31 and 16.04 weeks, 1.90 and 9.35 weeks, and 3.93 and 14.62 weeks for callus distraction, single-stage lengthening, and the combination procedure, respectively. Our findings indicate that the callus distraction technique is associated with greater length gained but results in greater complication rates and requires almost twice the time to heal. Single-stage lengthening with a bone graft was associated with fewer complications and faster healing times than callus distraction but with lesser gains in length. From the information reported in the studies we reviewed, the prevalence of bilateral brachymetatarsia was 44.52%, and the female/male ratio was 13.7:1. Both of these findings seem to contradict the usual data given (72% for bilateral brachymetatarsia and a female/male ratio of 25:1).
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Affiliation(s)
- Marc D Jones
- Staff Podiatrist, Mann-Grandstaff Veterans Affairs Medical Center, Spokane, WA.
| | | | - Sarah A Rincker
- Private Practitioner, Eugene Foot and Ankle Health Center, Eugene, OR
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Smolle E, Scheipl S, Leithner A, Radl R. Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): a case series. Foot Ankle Int 2015; 36:325-9. [PMID: 25377391 DOI: 10.1177/1071100714557520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Elisabeth Smolle
- Department of Othopedic Surgery, Medical University of Graz, Graz, Austria
| | - Susanne Scheipl
- Department of Othopedic Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Othopedic Surgery, Medical University of Graz, Graz, Austria
| | - Roman Radl
- Department of Trauma Surgery, Medical University of Graz, Graz, Austria
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Giuffra V, Bianucci R, Milanese M, Tognotti E, Montella A, Caramella D, Fornaciari G, Bandiera P. A Case of Brachymetatarsia From Medieval Sardinia (Italy). Anat Rec (Hoboken) 2014; 297:650-2. [DOI: 10.1002/ar.22883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/06/2013] [Accepted: 12/20/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Valentina Giuffra
- Division of Paleopathology, Department of Translational Research on New Technologies in Medicine and Surgery; University of Pisa; Via Roma 57 56126 Pisa Italy
| | - Raffaella Bianucci
- Division of Paleopathology, Department of Translational Research on New Technologies in Medicine and Surgery; University of Pisa; Via Roma 57 56126 Pisa Italy
- Department of Public Health and Pediatric Sciences; Laboratory of Physical Anthropology, University of Turin; C.so Galileo Galilei, 22 10126 Turin Italy
| | - Marco Milanese
- Department of History; University of Sassari; Viale Umberto 52 07100 Sassari Italy
| | - Eugenia Tognotti
- Department of Biomedical Sciences; University of Sassari; Viale San Pietro 43/B 07100 Sassari Italy
| | - Andrea Montella
- Department of Biomedical Sciences; University of Sassari; Viale San Pietro 43/B 07100 Sassari Italy
| | - Davide Caramella
- Division of Diagnostic and Interventional Radiology, Department of Translational Research on New Technologies in Medicine and Surgery; University of Pisa; Via Roma 57 56126 Pisa Italy
| | - Gino Fornaciari
- Division of Paleopathology, Department of Translational Research on New Technologies in Medicine and Surgery; University of Pisa; Via Roma 57 56126 Pisa Italy
| | - Pasquale Bandiera
- Department of Biomedical Sciences; University of Sassari; Viale San Pietro 43/B 07100 Sassari Italy
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Desai A, Lidder S, R Armitage A, S Rajaratnam S, D Skyrme A. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft. Orthop Rev (Pavia) 2013; 5:e21. [PMID: 24191181 PMCID: PMC3808796 DOI: 10.4081/or.2013.e21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/28/2013] [Accepted: 06/17/2013] [Indexed: 12/03/2022] Open
Abstract
A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech® screw (Biotech International, France) with the addition of two 1 cm cancellous cubes (RTI Biologics, United States). A lengthening zplasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.
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Affiliation(s)
- Ankit Desai
- Department of Trauma and Orthopaedics, Eastbourne District General Hospital , East Sussex, UK
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Abstract
Brachymetatarsia can be congenital, idiopathic or secondary and describes an abnormal shortening of a metatarsal bone. The indications for treatment are not only due to cosmesis. The shortening of a ray changes the biomechanics of the foot and can lead to metatarsalgia. A frequent clinical feature is dorsal dislocation of a toe causing painful shoe conflict and disturbed proprioception. There are three main options for operative correction: lengthening osteotomy, interposition of a tricortical bone and gradual lengthening by callus distraction. While one stage lengthening procedures such as osteotomy and interposition are more appropriate for correction of moderate length deficiencies, the callus distraction method is more suitable for larger elongation. Common to all procedures is a long-term treatment with a high risk of different complications whereby patient compliance can be problematical.
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Fu D, Zhou L, Yang S, Xiao B. Surgical technique: repair of forefoot skin and soft tissue defects using a lateral tarsal flap with a reverse dorsalis pedis artery pedicle: a retrospective study of 11 patients. Clin Orthop Relat Res 2013; 471:317-23. [PMID: 22972659 PMCID: PMC3528927 DOI: 10.1007/s11999-012-2598-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 08/30/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various authors have proposed flaps to reconstruct traumatic forefoot skin and soft tissue defects, especially with exposure of tendon and/or bone although which is best for particular circumstances is unclear. DESCRIPTION OF TECHNIQUE The indications for the technique were a forefoot defect area of no more than 8-cm × 8-cm and a well-preserved lateral tarsal (LT) donor site. The injured tendons were repaired using tendon grafts. The free dorsalis pedis flap was outlined by centering it on the cutaneous branch of the LT artery and tailoring it to the size of the wound, allowing 0.5-cm margins in length and width. The flap was rotated around the plantar perforating branch of the dorsalis pedis artery (DPA) to cover the forefoot defect. The lateral dorsalis pedis cutaneous nerve was anastomosed with the recipient plantar nerve stump. The donor site was covered with an inguinal, full-thickness skin graft. PATIENTS AND METHODS Traumatic forefoot skin and soft tissue defects with exposure of the tendon and/or bone involving 11 feet in 11 patients (mean age, 32 years) were covered using a LT flap with a reversed DPA pedicle. Three patients with forefoot defects underwent emergency repair within 8 hours of injury, whereas eight patients required delayed repair. All patients were followed up for at least 6 months (mean, 13 months; range, 6-24 months). RESULTS All flaps survived uneventfully, except for two that had superficial marginal necrosis or severe venous insufficiency. All skin grafts covering the donor sites survived and all wounds healed. None of the patients had restricted standing or walking at followups. The two-point discrimination was 4 mm to 10 mm at 6 months postoperative. The mean hallux-metatarsophalangeal-interphalangeal scale score was 93 points (range, 87-98 points). CONCLUSIONS Our observations suggest the LT flap with a reversed DPA pedicle is a reasonable option for repair of traumatic forefoot skin and soft tissue defects with exposure of tendon and/or bone but a well-preserved LT donor site and is associated with minimal morbidity.
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Affiliation(s)
- Dehao Fu
- />Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Liyi Zhou
- />Department of Orthopaedics, The Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Shuhua Yang
- />Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Baojun Xiao
- />Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Brown MJC, Yeoman TFM, Roberts S, Pillai A. Case report: a modified 1-stage technique for the treatment of brachymetatarsia. Foot Ankle Spec 2012; 5:389-93. [PMID: 23074293 DOI: 10.1177/1938640012463059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Brachymetatarsia is an abnormal shortening of a metatarsal. It causes disruption of the normal metatarsal parabola, resulting in metatarsalgia, calluses and dislocation of the digits. Patients often express discontent with the appearance of their feet. Lengthening by distraction osteogenesis and 1-stage intercalary bone grafting procedures are the mainstays of operative treatment. We present a modified 1-stage technique, combining the use of a Chevron osteotomy of the fourth metatarsal with shortening osteotomies of the second and third metatarsals. Bone removed from the third metatarsal was used to lengthen the fourth. The Chevron segments provided mediolateral, dorsoplantar, and rotational stability. The technique was used on both feet of 1 patient. The mean increase in AOFAS score was 34.5 (right foot, 46; left foot, 23.) There were no complications. A 1-stage technique does not require an external fixator or postoperative manipulation and has a quicker healing time. Taking the bone graft from neighboring metatarsals decreases the discrepancy between metatarsal lengths. A smaller increase in the length of the fourth ray is then required, and the chance of neurovascular injury as a result of soft-tissue stretching is minimized. This technique allows restoration of the metatarsal parabola and provides good correction, immediate stability, and good integration. LEVELS OF EVIDENCE Therapeutic Level IV, Case Study.
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Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopaedics and Pediatrics, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
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Abstract
The treatment of congenital abnormalities of the lesser toes should be individualized to the pathology present. Goals of treatment include pain relief, proper alignment of the toes, and comfort with wearing shoes. Meticulous surgical technique can minimize complications and optimize clinical outcomes for these patients.
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Affiliation(s)
- Ho-Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Lamm BM, Gourdine-Shaw MC. Problems, obstacles, and complications of metatarsal lengthening for the treatment of brachymetatarsia. Clin Podiatr Med Surg 2010; 27:561-82. [PMID: 20934105 DOI: 10.1016/j.cpm.2010.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Metatarsal lengthening by distraction osteogenesis is a challenging procedure that is associated with various adverse results. This article presents and classifies adverse results arising from metatarsal lengthening. Our premise of classification is that not all adverse results that occur secondary to distraction osteogenesis of the metatarsal are true complications that affect the final outcome, but rather are problems and obstacles that present hurdles to completion of treatment. Our classification differentiates among problems, obstacles, and complications during metatarsal lengthening with external fixation. The cause of each adverse result is also discussed and clinical and surgical pearls to avoid these problems, obstacles, and complications are presented.
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Affiliation(s)
- Bradley M Lamm
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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