One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia.
BACKGROUND
Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft.


OBJECTIVE
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.


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.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Giannini
Sandro
S
Department of Orthopaedic and Trauma Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy. giannini@ior.it
Faldini
Cesare
C
Pagkrati
Stavroula
S
Miscione
Maria Teresa
MT
Luciani
Deianira
D
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005532:Foot Deformities, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016348:Osseointegration; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D055815:Young Adult