One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

Sandro Giannini MD, Cesare Faldini MD, Stavroula Pagkrati MD, Maria Teresa Miscione MD, Deianira Luciani MD
Surgical Technique
Volume 468, Issue 7 / July , 2010

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Abstract

Background

Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft.

Questions/purposes

We asked whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance.

Patients and Methods

We retrospectively reviewed 29 patients (41 feet) in whom we lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Minimum followup was 3 years (mean, 5 years; range, 3–11 years).

Results

Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28–53 points) and the mean postoperative score was 88 points (range, 74–96 points), with an average improvement of 51 points. Radiographically, the mean gain in length was 13 mm (range, 10–15 mm), and the mean percentage increase was 23%.

Conclusions

One-stage metatarsal lengthening using interposition of metatarsal homologous bone graft to correct congenital brachymetatarsia has low morbidity for the patient, limited complications, short recovery times, and restores forefoot anatomy.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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