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Xiao T, Qin H, Deng P, Lin J, He S, Zhang X, Hu X. An unusual case of traumatic injury to the first metatarsal a case report. Heliyon 2024; 10:e30040. [PMID: 38720761 PMCID: PMC11076902 DOI: 10.1016/j.heliyon.2024.e30040] [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: 11/14/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
A 44-year-old male sustained trauma to his foot leading to a 5-cm defect of the first metatarsal bone and infection of the bone by Staphylococcus aureus. Osteotomy is the most suitable method for treating large metatarsal defects complicated with osteomyelitis, however few reports have been published on this challenging approach. In this case, osteotomy and external fixation for distraction were performed. Finally, the osteomyelitis of the patient was well controlled, the bone length was restored, and the patient could carry weight completely, and the treatment effect was satisfactory.
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Affiliation(s)
- Tinghui Xiao
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Hanjun Qin
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Peizhi Deng
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Jiandong Lin
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Siying He
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Xiaoming Zhang
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
| | - Xinjia Hu
- Department of Traumatic Orthopedics, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen, China
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2
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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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3
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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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4
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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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5
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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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Kim DG, Lee YH, Nam IH, Choi YD. Long Term Result of Weil Osteotomy and Callotasis for Bilateral Brachymetatarsia: A Case Report. J Orthop Case Rep 2019; 9:84-86. [PMID: 31559236 PMCID: PMC6742876 DOI: 10.13107/jocr.2250-0685.1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Brachymetatarsia can be treated by lengthening of the affected metatarsals or shortening of the normal neighboring metatarsals. Combination of the two methods may be more effective rather than using one skill due to less complications. Case Report: A 56-year-old female patient with the bilateral first, fourth-ray brachymetatarsia underwent Weil osteotomy of the second, third, fifth metatarsals, and callotasis of the fourth metatarsal. Follow-up examination had been carried out since the surgery was done about 10 years ago. Conclusions: In the decade after observation, the patient was very satisfied with the shape and function of the feet, and no complications occurred.
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Affiliation(s)
- Dae Geun Kim
- Department of Orthopedic Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Yeong Hyeon Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Il Hyun Nam
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Young Duk Choi
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
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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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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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Fusini F, Langella F, Catani O, Sergio F, Zanchini F. Mini-Invasive Treatment for Brachymetatarsia of the Fourth Ray in Females: Percutaneous Osteotomy With Mini-Burr and External Fixation-A Case Series. J Foot Ankle Surg 2017; 56:390-394. [PMID: 28089127 DOI: 10.1053/j.jfas.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Indexed: 02/03/2023]
Abstract
Brachymetatarsia is a rare disease defined by metatarsal shortening and characterized by aesthetic dissatisfaction with or without pain. The aim of our study was to evaluate the outcomes of fourth ray brachymetatarsia treated with percutaneous osteotomy using a mini-burr and gradual lengthening with external fixation. A total of 7 females were recruited for the study; 6 (85.71%) of whom had a bilateral deformity, for a total of 13 feet affected by fourth ray brachymetatarsia. Percutaneous diaphysis osteotomy with a mini-burr followed by metatarsal elongation was performed. Metatarsal lengthening was measured as the difference between the preoperative and postoperative length at external fixator removal. The American Orthopaedic Foot and Ankle Society lesser toe metatarsophalangeal-interphalangeal score, patient satisfaction, restoration of Leliévre parabola, and treatment time were evaluated. Numerical data are reported as the mean ± standard deviation and 95% confidence intervals. The Mann-Whitney U test was used to compare the changes in the AOFAS score with a level of significance of p < .05. The mean metatarsal lengthening was 17.46 ± 4.89 (95% confidence interval [CI] 14.8 to 20.12) mm and the mean treatment time was 99.23 ± 8.53 (95% CI 94.59 to 103.87) days. The mean American Orthopaedic Foot and Ankle Society lesser toe metatarsophalangeal-interphalangeal score improved significantly from 76.38 ± 2.66 (95% CI 74.77 to 78.03) preoperatively to 86.46 ± 1.45 (95% CI 84.85 to 88.07) postoperatively (p < .01). In 12 of 13 feet (92.31%), the Leliévre parabola was restored, and the patients were satisfied with the clinical outcomes. The results of our study demonstrate that percutaneous osteotomy with the mini-burr and external fixation is an effective treatment for lengthening of fourth ray brachymetatarsia. Furthermore, we found good clinical and functional outcomes, high patient satisfaction, and a similar duration of treatment compared with other gradual lengthening procedures.
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Affiliation(s)
- Federico Fusini
- Resident Orthopaedic Surgeon, Clinical Orthopaedics, Second University of Naples, Naples, Italy.
| | - Francesco Langella
- Orthopaedic Surgeon, Clinical Orthopaedics, Second University of Naples, Naples, Italy
| | - Ottorino Catani
- Orthopaedic Surgeon, Department of Foot Surgery, Casa di cura Santa Rita, Avellino, Italy
| | - Fabrizio Sergio
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatology, San Rocco Hospital, Caserta, Italy
| | - Fabio Zanchini
- Orthopaedic Surgeon, Clinical Orthopaedics, Second University of Naples, Naples, Italy
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10
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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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Forootan KS, Forootan NS, Lebaschi AH. Results of distraction callus osteogenesis in hand and foot in Iran: A 15-year experience. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:454-9. [PMID: 26487873 PMCID: PMC4590199 DOI: 10.4103/1735-1995.163965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Distraction osteogenesis (DS) is currently an important technique for lengthening shortened bones of the hand and foot. Authors report their experience in applying DS for various conditions of the hand and foot using a distractor that the senior author has designed. MATERIALS AND METHODS Records of patients who underwent DS for hand and foot conditions in a private clinic were retrieved between January 2001 and January 2015. Data concerning distraction, outcome, and complications were recorded. RESULTS There were 17 patients, 7 males, and 10 females with a total 24 distractions. The mean length gained was 21.2 mm (1.69) and the mean total treatment time was 198.58 (15.88) days. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions. Minor complications occurred in 7 (29.2%) distractions. CONCLUSION DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions. Joint stiffness/contracture is an important complication following DS of the metatarsals.
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Affiliation(s)
- Kamal Seyed Forootan
- Department of Hand and Microscopic Surgery, Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Amir Hussein Lebaschi
- Department of Plastic and Reconstructive Surgery, Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
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12
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Vekris M, Lykissas M, Pakos E, Gelalis I, Korompilias A, Soucacos P, Beris A. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury 2015; 46:1354-8. [PMID: 25702251 DOI: 10.1016/j.injury.2015.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/20/2015] [Accepted: 01/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to present the long-term radiographic results with distraction osteogenesis in traumatic or congenital length discrepancies of long bones of the hand. METHODS The medical records and radiographs of 65 consecutive patients (27 metacarpals and 55 phalanges) with either traumatic or congenital digital length discrepancies were retrospectively reviewed. The mean follow-up was 8.2 years. The mean distraction period was 21 days with a distraction rate of 4×0.25mm/day. Callus consolidation was obtained in all patients. RESULTS The bones were lengthened by a mean amount of 17.5mm, with a mean increase in bone length of 68±17.3%. The mean healing index was 28.57 days/cm. Ray reconstruction with callus distraction can be applied effectively in skeletally immature or mature patients with congenital differences of the hand or amputated fingers. CONCLUSION A distraction rate of 1mm/day proved to be a safe rate of lengthening in both metacarpals and phalanges.
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13
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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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14
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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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15
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Kim HN, Jeon JY, Dong Q, Kim HK, Park YW. Prevention of cavus foot deformity following gradual distraction osteogenesis for first brachymetatarsia--technique tip. Foot Ankle Int 2014; 35:300-3. [PMID: 24240100 DOI: 10.1177/1071100713513237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hyong Nyun Kim
- Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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16
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A new surgical procedure for brachymetatarsia by a hydroxyapatite graft. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0729-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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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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18
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Lee KB, Park HW, Chung JY, Moon ES, Jung ST, Seon JK. Distraction Osteogenesis for First and Fourth Brachymetatarsia: Based on an original article: J Bone Joint Surg Am. 2010;92:2709-18. JBJS Essent Surg Tech 2011; 1:e1. [PMID: 33738126 DOI: 10.2106/jbjs.st.k.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Keun-Bae Lee
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
| | - Hyeong-Won Park
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
| | - Jae-Yoon Chung
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
| | - Eun-Sun Moon
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
| | - Sung-Taek Jung
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
| | - Jong-Keun Seon
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, 671, Jebongro, Donggu, Gwangju, 501-757, Republic of Korea. E-mail address:
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Lee KB, Park HW, Chung JY, Moon ES, Jung ST, Seon JK. Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia. J Bone Joint Surg Am 2010; 92:2709-18. [PMID: 21084581 DOI: 10.2106/jbjs.i.00338] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachymetatarsia is the presence of an abnormally short metatarsal, and distraction osteogenesis has been used for its treatment. The purpose of the present study was to compare the outcomes of patients who underwent distraction osteogenesis for the treatment of first and/or fourth brachymetatarsia. METHODS The data from forty-eight patients (sixty-four feet, seventy-four metatarsals) who underwent distraction osteogenesis for the treatment of brachymetatarsia were reviewed. The indications for surgery included a metatarsal that was at least 10 mm shorter than the adjacent metatarsal and that had an unacceptable cosmetic appearance. The study group comprised thirty-two first brachymetatarsia in nineteen patients (Group A) and forty-two fourth brachymetatarsia in twenty-nine patients (Group B). The average age was twenty years in Group A and eighteen years in Group B. The average duration of follow-up was 58.1 months in Group A and 56.1 in Group B. Metatarsal length, lengthening gain, healing time and index, and the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal and lesser metatarsophalangeal-interphalangeal scores were evaluated. RESULTS All patients were satisfied with the final length of the metatarsal and all had achieved bone union at the time of the last follow-up. The mean lengthening gain was 17.2 mm (42.9%) in Group A and 16.3 mm (37.3%) in Group B. The mean healing index was 71.0 days/cm in Group A and 67.3 days/cm in Group B. The mean American Orthopaedic Foot and Ankle Society score was 91.2 points in Group A and 92.8 points in Group B at the last follow-up (twenty-two excellent, nine good, and one fair results in Group A, and twenty-nine excellent, eleven good, and two fair results in Group B). The most common complication was metatarsophalangeal joint stiffness, which occurred in thirteen rays in Group A and in twelve rays in Group B; malalignment of the lengthened metatarsal was observed six times in each group. No significant intergroup differences in the outcomes were found. CONCLUSIONS Distraction osteogenesis for first and/or fourth brachymetatarsia provided successful lengthening of a metatarsal with eventual osseous union and was associated with similar outcomes in terms of healing index, function score, and the prevalence of complications between the two groups, although frequent complications were encountered and no improvement in foot function was found.
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Affiliation(s)
- Keun-Bae Lee
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, South Korea.
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Giannini S, Faldini C, Pagkrati S, Miscione MT, Luciani D. One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia. Clin Orthop Relat Res 2010; 468:1933-42. [PMID: 20058111 PMCID: PMC2882014 DOI: 10.1007/s11999-009-1212-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 12/16/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft. QUESTIONS/PURPOSES We asked whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance. PATIENTS AND METHODS We retrospectively reviewed 29 patients (41 feet) in whom we lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Minimum followup was 3 years (mean, 5 years; range, 3-11 years). RESULTS Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28-53 points) and the mean postoperative score was 88 points (range, 74-96 points), with an average improvement of 51 points. Radiographically, the mean gain in length was 13 mm (range, 10-15 mm), and the mean percentage increase was 23%. CONCLUSIONS One-stage metatarsal lengthening using interposition of metatarsal homologous bone graft to correct congenital brachymetatarsia has low morbidity for the patient, limited complications, short recovery times, and restores forefoot anatomy. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sandro Giannini
- Department of Orthopaedic and Trauma Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
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Lee WC, Yoo JH, Moon JS. Lengthening of fourth brachymetatarsia by three different surgical techniques. ACTA ACUST UNITED AC 2009; 91:1472-7. [DOI: 10.1302/0301-620x.91b11.22169] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p < 0.000). The clinical outcome was compared in the three groups. The mean follow-up was 22 months (7 to 55). At final follow-up, the mean lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p < 0.000). The saw group included eight feet with failure of bone formation after surgery. Additional operations were performed in 20 feet because of stiffness (n = 7, all groups), failure of bone formation (n = 4, saw group), skin maceration (n = 4, bone-graft group), malunion (n = 4, bone-graft and saw groups) and breakage of the external fixator (n = 1, saw group). We conclude that the gradual lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.
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Affiliation(s)
- W.-C. Lee
- Department of Orthopaedic Surgery Seoul Paik Hospital, College of Medicine, Inje University, 85, 2-ga, Jeo-dong, Jung-Gu, Seoul 100-032, Korea
| | - J. H. Yoo
- Department of Orthopaedic Surgery Soonchunhyang Hospital, College of Medicine, Soonchunhyang University, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do 420-767, Korea
| | - J.-S. Moon
- Department of Orthopaedic Surgery Seoul Paik Hospital, College of Medicine, Inje University, 85, 2-ga, Jeo-dong, Jung-Gu, Seoul 100-032, Korea
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Lee WC, Suh JS, Moon JS, Kim JY. Treatment of brachymetatarsia of the first and fourth ray in adults. Foot Ankle Int 2009; 30:981-5. [PMID: 19796592 DOI: 10.3113/fai.2009.0981] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review our results of treatment for brachymetatarsia involving the first and fourth ray. MATERIALS AND METHODS This study includes 47 feet of 30 patients who have been treated for brachymetatarsia of the first and fourth rays. The average age of patients was 26.4 (range, 20 to 36) years. The second and third metatarsals were shortened in 44 feet. In 41 feet, the fourth metatarsals were lengthened at one stage with resected bones from the second and third metatarsals. The lengthening or shortening of each metatarsal was recorded. American Orthopaedic Foot and Ankle Society score and subjective satisfaction were obtained for the clinical evaluation. RESULTS The average amount of shortening in the second and third metatarsal was 8.9 +/- 2.8 mm and 7.2 +/- 2.6 mm respectively. The average amount of lengthening in the fourth metatarsal was 10.3 +/- 4.1 mm. Postoperative AOFAS score was 83.2 +/- 7.6. Stiffness of the fourth metatarsophalangeal joint was the most common cause of functional deficit. All except three patients were satisfied with some reservation. Additional operations were performed on eleven feet. CONCLUSION Most adult patients with the first and fourth ray brachymetatarsia have been subjectively satisfied with the treatment with some loss of function mostly due to stiffness of the metatarsophalangeal joints.
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Affiliation(s)
- Woo-Chun Lee
- Inje University, Orthopaedic Surgery, 85, Jeo-dong, Jung-gu, Seoul 100-032, Republic of Korea.
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Erdem M, Sen C, Eralp L, Kocaoğlu M, Ozden V. Lengthening of short bones by distraction osteogenesis--results and complications. INTERNATIONAL ORTHOPAEDICS 2007; 33:807-13. [PMID: 18092161 DOI: 10.1007/s00264-007-0491-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 10/11/2007] [Accepted: 10/12/2007] [Indexed: 11/26/2022]
Abstract
We performed bone lengthening surgery on 12 metacarpals and 14 metatarsals of 15 patients. The mean age for metacarpal and metatarsal lengthening was 14.5 (10-21) and 17.5 (10-25) years, respectively. We used a unilateral or a circular external fixator. The mean healing index of the metacarpals and metatarsals was 1.6 (1.1-2.3) and 1.6 (1.0-2.0) months/cm, respectively. The mean increase in metacarpal and metatarsal length was 17.6 (13-26) and 24.3 (20-30) mm, respectively. The functional scores of the metatarso-phalangial (MTP) joint of lengthened metatarsals for the lesser toe were excellent in 12 and good in two cases based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Complications were seen in six of the metatarsal lengthening cases including four angulations, one subluxation and one non-union. We conclude that the periosteum must be protected with percutaneous osteotomy and lengthening should be performed at a rate of 0.25 mm twice a day and should not exceed 40% of the original bone length (or >20 mm).
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Affiliation(s)
- Mehmet Erdem
- Orthopedics and Traumatology, Gaziosmanpasa University, Gaziosmanpasa Universitesi Tip Fakultesi, Ortopedi ve Travmatoloji Anabilim Dali, Tokat, Turkey.
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Dogan A, Uslu M, Aydinlioglu A, Harman M, Akpinar F. Morphometric study of the human metatarsals and phalanges. Clin Anat 2007; 20:209-14. [PMID: 16795031 DOI: 10.1002/ca.20348] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mathematical relation between metatarsals and between phalanges in terms of their lengths and widths in themselves is considered to be significant with respect to its functional and aesthetic roles. The objective of this study is to conduct measurements for determining lengths and widths of metatarsals and phalanges on the foot radiographs and to determine possible mathematical correlations between metatarsals themselves and between phalanges themselves in terms of their lengths and widths. Anteroposterior right and left foot radiographs were taken from 100 volunteers (50 men and 50 women). Lengths and widths of the metatarsals and phalanges were measured in millimeter on radiographs. The mean, minimum and maximum values, and standard deviations of each bone's length and width were studied and data were put into formulation. The results were evaluated by Regression statistical test, and the relation between metatarsals and between phalanges in terms of their lengths and widths was studied. As a result of the measurements, we found fixed proportions between metatarsals in themselves and between phalanges in themselves in terms of their lengths and widths. Knowing these morphometric relations may be useful for performing any surgical procedures designed to manage any defects or imperfections of the foot, chief among them is shortness.
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Affiliation(s)
- Ali Dogan
- Department of Orthopedics and Traumatology, Medical Faculty of Yuzuncu Yil University, Van, Turkey.
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Yamada N, Yasuda Y, Hashimoto N, Iwashiro H, Uchinuma E. Use of internal callus distraction in the treatment of congenital brachymetatarsia. ACTA ACUST UNITED AC 2005; 58:1014-9. [PMID: 16039626 DOI: 10.1016/j.bjps.2005.04.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 04/28/2005] [Indexed: 11/19/2022]
Abstract
Congenital bilateral brachymetatarsia of the fourth metatarsal bone was treated by osteotomy and bone lengthening using the internal distraction technique. The patient was cosmetically improved. This technique has some advantages over the method of external distraction.
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Affiliation(s)
- Naoto Yamada
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato Sagamihara, Kanagawa 228-8555, Japan.
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Abstract
Brachymetatarsia is a rare clinical entity that presents a complicated case to the treating surgeon. One-stage lengthening procedures with a variety of biologic and synthetic implants are preferred for metatarsals that only need to be lengthened up to 15 mm, whereas gradual lengthening allows for greater length gain and concomitant lengthening of the soft tissues. Adjacent metatarsal shortening may be used in conjunction with lengthening procedures to restore the parabolic arc of the metatarsal heads. Management should be tailored to the patient's individual deformity and expectations. Individualization of surgical techniques and patient selection criteria can result in a cosmetic, functional result that is satisfactory to the clinician and the patient.
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Affiliation(s)
- Aimee Schimizzi
- Department of Orthopaedics, UCSD Medical Center, 200 West Arbor Drive, #8894, San Diego, CA 92103, USA
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