Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review

Abstract

BackgroundThis study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. MethodsFour feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal–interphalangeal scale, and any complications were recorded. ResultsThe patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6–28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1–18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7–41.1 %). The mean AOFAS score (0−100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1–11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. ConclusionSubacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.