Fourth brachymetatarsia treated with distraction osteogenesis.
BACKGROUND
This study investigated metatarsal lengthening by distraction osteogenesis for fourth brachymetatarsia in 22 metatarsals (16 patients).


METHODS
From May 1997 to May 2000, lengthening was performed with a monoexternal fixator, and distraction was started at a rate of 0.5 mm per day after a latency period of approximately 7-10 days.


RESULTS
The average gain in length was 16.5 mm (range, 13-21 mm), equivalent to an increase of 39% (range, 28-51%), and the average healing index was 72.9 days/cm (range, 51.7-95.7 days/cm). The American Orthopaedic Foot and Ankle Society (AOFAS) average score for lesser toe was 86.3 (range, 47-100). The most common residual complication was subluxation of metatarsophalangeal (MTP) joint in five cases, with partial or total stiffness of the MTP joint. These complications happened in the group of metatarsals excessively lengthened more than 40% and made the AOFAS score poorer. The other complications were three cases of angular deformity in the lengthened bone, and two cases of pin-tract infection.


CONCLUSIONS
Although distraction osteogenesis is an effective method to address fourth brachymetatarsia, stiffness or subluxation of the MTP joint was not uncommon. To avoid complications that can happen as a result of excessive lengthening, careful preoperative radiographic measurement to calculate the optimal amount of lengthening may help us to avoid overlengthening and the complications that accompany it.
Song
Hae-Ryong
HR
Gyeongsang National University Hospital, Chinju, Korea.
Oh
Chang-Wug
CW
Kyung
Hee-Soo
HS
Kim
Sung-Jung
SJ
Guille
James T
JT
Lee
Sung-Man
SM
Kim
Poong-Taek
PT
D000293:Adolescent; D000328:Adult; D005260:Female; D005530:Foot Deformities / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000002:abnormalities* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*