Tratamiento de la braquimetatarsia mediante osteogénesis a distracción

Abstract

Introducion and objectivesBrachymetatarsia is defined as the abnormal shortening of one or more metatarsals. Several surgical techniques had been described for its treatment. The aim of this study is to present our experience in the treatment of brachymetatarsia with distraction osteogenesis with external fixator, as well as to analyse the results and its complications. Material and methodsBetween May 2009 and January 2015, 7 patients (8 feet) aged from 8 to 18 years, diagnosed with brachymetatarsia, underwent surgery based on distraction osteogenesis with external fixator. The lengthening was performed in metatarsal 4 (M4) (4 feet), M3 (1 foot), M2 (1 foot), and M1 (bilateral lengthening in a patient affected by Pfeiffer syndrome). Surgery for concomitant hallux valgus was carried out in 3 patients (2 Chevron osteotomies and 1 percutaneous correction). All patients underwent percutaneous osteotomy of the affected metatarsal, dorsal percutaneous metatarsophalangeal joint (MPJ) capsulotomy and extensor tenotomy and metatarsal lengthening with external fixator in a 0.5mm daily rhythm. Step by step surgical technique and postoperative care are described. Results are measured with postoperative x-rays (final lengthening, percentage of lengthening, healing index), American Orthopaedic Foot and Ankle Society (AOFAS) scale, and complications. ResultsThe large majority (90%) of patients were satisfied with the cosmetic appearance, the final lengthening, and the relief of symptoms. The mean lengthening was 21mm (17-31mm), and the mean percentage of lengthening was 46.1% (30.2-81.5%). The mean healing index was 71.2 day/cm (51.9-95.7 day/cm). The mean AOFAS score was 90.5 (80-100). Stiffness was the most common complications, occurring in 3 patients who needed physical therapy and arthrolysis at the time of removing the fixator. There was 1 fracture of the lengthened bone, 1 superficial infection, and 1 delay in healing. ConclusionsDistraction osteogenesis is a safe procedure for treating brachymetatarsia in the paediatric and adolescent population. It can avoid the iatrogenic neurovascular complications described in one-staged lengthening. However MPJ stiffness must be avoided in order to get an excellent result.