Treatment of Complications after Distraction Osteogenesis for Brachymetatarsia of the Fourth Metatarsal

A Novel Technique-Bone Splitting and Bone Grafting in an Hourglass-shaped Bone Following Distraction Osteogenesis

Aim

We describe a novel technique of bone splitting and bone grafting in managing hypoplastic or hourglass-shaped regenerated bone in distraction osteogenesis.

Background

Hourglass-shaped regenerated bone is a potential complication during distraction osteogenesis which is vulnerable to fracture when loaded. Our novel technique overcomes this by increasing the diameter of new bone formation via bone splitting and bone grafting.

Case description

We report three cases with hypoplastic regenerated bone following distraction osteogenesis. It was treated with bone splitting and bone grafting. Although one case was complicated with an iatrogenic transverse fracture during the surgery, all three cases achieved the goal of increasing bone diameter during the subsequent consolidation phase.

Conclusion

This relatively simple and novel surgical intervention can overcome the hourglass-shaped appearance, thus preventing potential fracture.

Clinical significance

We emphasise the importance of identifying hypoplastic regenerate bone before the consolidation phase of distraction osteogenesis. The novel technique described is a simple surgical intervention which can prevent potential fracture through the newly formed bone.

How to cite this article

Lee HS, Tasarib R, Hamzah FC, et al. A Novel Technique—Bone Splitting and Bone Grafting in an Hourglass-shaped Bone Following Distraction Osteogenesis. Strategies Trauma Limb Reconstr 2020;15(3):175–178.

Literature Review on Brachymetatarsia

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.