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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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Arata J, Kumakiri M, Yamashita T, Kaito S. Nonincisional Osteotomy for Gradual Lengthening by Callus Distraction for Congenital Brachymetatarsia. J Foot Ankle Surg 2021; 60:1293-1296. [PMID: 34303576 DOI: 10.1053/j.jfas.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/25/2021] [Indexed: 02/03/2023]
Abstract
Gradual lengthening by distraction osteogenesis is widely used for congenital brachymetatarsia. The usual presenting complaint is the patient's cosmetic appearance. Osteotomy is an integral element. A nonincisional surgical approach for osteotomy can reduce dorsal longitudinal scarring and help preserve the periosteal blood supply to the bone during surgical dissection. Between June 2003 and January 2019, we performed gradual lengthening by callus distraction with nonincisional osteotomy for congenital brachymetatarsia on 13 digits in 5 patients. All 5 patients were female, and their average age was 18 years old. The lengthened bones involved 3 first metatarsals, 2 third metatarsal, and 8 fourth metatarsal bones. The mean gain in length was 15.2 mm (10-21 mm). The mean duration of distraction was 36.2 days (30-48 days). The mean duration of consolidation was 62.8 days (28-103 days). The lengthened segment consolidated in all cases. One patient had early consolidation and did not wish to undergo further surgery. There were no cases of trouble due to drilling for osteotomy. All patients had a normal gait and were satisfied with the cosmetic results.
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Affiliation(s)
- Jun Arata
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
| | - Masanori Kumakiri
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Teruyo Yamashita
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shuko Kaito
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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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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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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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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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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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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10
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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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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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12
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Hosny GA, Ahmed ASA. Distraction osteogenesis of fourth brachymetatarsia. Foot Ankle Surg 2016; 22:12-6. [PMID: 26869494 DOI: 10.1016/j.fas.2015.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/12/2015] [Accepted: 03/05/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Brachymetatarsia is a rare congenital or developmental condition that results in a short metatarsal. The condition most commonly affects the fourth metatarsal of young and adolescent females. It does not usually produce a functional problem. However, it may produce a significant cosmetic problem especially in young women. The authors present their experience in gradual distraction of the fourth metatarsal to tackle this problem in adults. METHODS That was done using a monolateral frame in 11 feet of female patients with an average age of 23 years. Evaluation depended upon the achievement of the target length, angulation, pain, and satisfaction of the patient. RESULTS There were eight excellent and three good results after an average follow up of 2.6 years. Aside from nine cases of mild pin-tract infection, complications were few and minor. CONCLUSIONS We recommend distraction osteogenesis as the treatment of choice for brachymetatarsia of the fourth toe.
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13
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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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14
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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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16
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Haleem AM, Mintz DN, Rozbruch SR. Metatarsophalangeal arthritis following fourth metatarsal lengthening treated with distraction arthroplasty: case report. Foot Ankle Int 2014; 35:1075-81. [PMID: 25037710 DOI: 10.1177/1071100714543648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Amgad M Haleem
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
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17
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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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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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Nonincisional Osteotomy for Gradual Lengthening by Callus Distraction in the Hand and Foot. Ann Plast Surg 2011; 67:232-4. [DOI: 10.1097/sap.0b013e3181f77a9b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bibbo C, Jaffe L, Goldkind A. Complications of digital and lesser metatarsal surgery. Clin Podiatr Med Surg 2010; 27:485-507. [PMID: 20934100 DOI: 10.1016/j.cpm.2010.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Complications associated with digital and lesser metatarsal surgical procedures have been well documented in the literature. These complications may stem from systemic medical, structural, biologic, biomechanical, or iatrogenic causes. The surgeon must be cognizant of all potential complications, including ways to prevent them from occurring and how to manage them when they do occur. This article discusses preventative measures through the preoperative evaluation of the patient, and examines the subsets of complications that may occur after lesser ray surgery that pose a particular management challenge, as well as special complications specific to particular operative techniques.
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Affiliation(s)
- Christopher Bibbo
- Foot and Ankle Service, Department of Orthopaedics, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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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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