Anatomical reconstruction of the fourth brachymetatarsia with one-stage iliac bone and cartilage cap grafting.
BACKGROUND
We present a one-stage procedure for lengthening the fourth brachymetatarsia with autogenous iliac bone and cartilage cap grafting for the anatomical reconstruction of the metatarsophalangeal (MTP) joint METHODS: During the last 8 years, 56 feet in 41 patients with congenital brachymetatarsia of the fourth toe were corrected with a one-stage operation to reposition the articular cartilage cap to the distal part of interpositional iliac bone graft at the metatarsal epiphysis.


RESULTS
The length of the harvested iliac bone graft was 22.9 mm on average. The mean fixation period was 58.5 days, and the mean gain in length and percentage increase was 20.9 mm and 39%, respectively. MRI showed a stable MTP joint over viable cartilage cap in 83.3% of the cases. Mean postoperative American Orthopedic Foot and Ankle Society lesser MTP-interphalangeal score was 82.0. Neither neurovascular impairment nor recurrence of brachymetatarsia occurred in the mean follow-up period of 43.6 months. All patients were satisfied with the postoperative cosmetic results. Thirteen patients (23.2%) complained of limited active dorsiflexion of the fourth toe, and extensor adhesion was released by extensor tenolysis in only one patient. In a single case of nonunion at the bone graft site, additional surgery was not necessary.


CONCLUSIONS
Anatomical reconstruction of the fourth brachymetatarsia with one-stage interpositional iliac bone and cartilage cap grafting resulted in excellent cosmetic results and a physiologic MTP joint, providing the benefits of one-stage lengthening with a low complication rate.


METHODS
Therapeutic, IV.
Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Republic of Korea.
Sang Hyun
SH
Woo
Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Republic of Korea. Electronic address: bangcy@naver.com.
Chi Young
CY
Bang
W Institute for Foot and Ankle Surgery, W Hospital, Daegu, Republic of Korea.
Hee-Chan
HC
Ahn
W Institute for Foot and Ankle Surgery, W Hospital, Daegu, Republic of Korea.
Sung-Jung
SJ
Kim
W Institute for Foot and Ankle Surgery, W Hospital, Daegu, Republic of Korea.
Jun-Young
JY
Choi
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002356:Cartilage / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008682:Metatarsal Bones / Q000002:abnormalities* / Q000601:surgery; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
Autogenous iliac bone graft; Brachymetatarsia; Cartilage cap; One-stage lengthening