title: Gradual Metatarsal Lengthening by External Fixation: A New Classification of Complications and a Stable Technique to Minimize Severe Complications.
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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 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 d.barbier.mail@gmail.com.
authors.forename: Dominique
authors.initials: D
authors.lastname: Barbier
authors.affiliation: Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.
authors.forename: Andrei
authors.initials: A
authors.lastname: Neretin
authors.affiliation: Service d'orthopédie pédiatrique, Hôpital des Enfants, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Journeau
authors.affiliation: Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Popkov
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016267:External Fixators; D005260:Female; D005532:Foot Deformities, Congenital / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000002:abnormalities* / Q000601:surgery*; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy; D011183:Postoperative Complications / Q000145:classification* / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ilizarov; brachymetatarsia; callus; distraction; distraction osteogenesis; foot deformity; forefoot disorders; lengthening classification; metatarsalgia