title: Callus Distraction Versus Single-Stage Lengthening With Bone Graft for Treatment of Brachymetatarsia: A Systematic Review.
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).
authors.affiliation: Staff Podiatrist, Mann-Grandstaff Veterans Affairs Medical Center, Spokane, WA. Electronic address: marcdjones@gmail.com.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Jones
authors.affiliation: Staff Podiatrist, Canton-Potsdam Hospital, Potsdam, NY.
authors.forename: David M
authors.initials: DM
authors.lastname: Pinegar
authors.affiliation: Private Practitioner, Eugene Foot and Ankle Health Center, Eugene, OR.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Rincker
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005532:Foot Deformities, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000002:abnormalities / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000002:abnormalities / Q000601:surgery; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: congenital deformity; external fixation; metatarsal; surgery