Congenital brachymetatarsia

one-stage lengthening with allograft interposition and plate fixation

Abstract

Objective: Brachymetatarsia is the congenital metatarsal shortening. Metatarsal lengthening can be performed progresevely with external fixator or as a one-stage procedure, with bone graft interposition. The purpose of this study is to present the clinical and radiological outcomes. Methods: We performed a retrospective evaluation of patients with brachymetatarsia, treated with one-stage lengthening with allograft interposition and plate fixation, between 2006 and 2014 at Unidad de pié y tobillo at Hospital de Clinicas Caracas. We evaluated patient satisfaction and function, osteotomy fusion and metatarsal parabola correction. Results: We evaluated 22 patients (23 feet), 16 women and 6 men, mean age 23 years (17-36 years). Six patients had 3rd and 4th metatarsal lengthening (one of them bilateral). The allograft length was between 10 and 22mm (mean 14). Five patients needed 4th metatarsal lengthening and 2nd and 3rd metatarsal shortening. Two patients had previous treatment with a similar procedure at a different center, needed revision surgery because of non union and graft resorption. All osteotomies healed completely; one patient at 5 months postop had a fracture in the distal union between the allograft and metatarsal bone and needed revision and bone grafting. All the patients but two manifested their satisfaction with the procedure. Conclusion: The congenital brachymetatarsia lengthening in one stage procedure with allograft and plate fixation, is an excellent therapeutic option, with good results for the patient, fast healing, low morbidity and low complication rate.