Clinical Outcomes of Distraction Osteogenesis in Fourth Brachymetatarsia / 대한정형외과학회잡지

ABSTRACT

Purpose@#Brachymetatarsia is a relatively rare disease that is characterized by one or more metatarsals shorter than the adjacent metatarsal bones by 5 mm or more. Corrective treatment is done, not only for cosmetic purposes but also to improve function. The aim of this study was to evaluate radiologic and clinical results after distraction osteogenesis using external fixators for the fourth brachymetatarsia. @*Materials and Methods@#From January 2005 to September 2018, 45 patients (60 cases) with brachymetatarsia who underwent distraction osteogenesis using external fixators and who were followed up for at least 6 months were studied retrospectively. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication, and the patient’s satisfaction were analyzed. The patient’s satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, based on the level of stiffness, pain, function, and alignment. @*Results@#The average gain in length and the percentage increase in the fourth metatarsals were 13.8 mm and 30.0%, and the mean followup period was 14.2 months after the removal of the external fixator. Bony union was obtained in the metatarsal bones in almost all the cases except for one case of non-union. According to the AOFAS score, 39 cases were rated excellent, and 6 cases were good at the final follow-up. The patients showed satisfactory cosmetic and functional results. Complications were pin site infections in 3 cases, all improved by oral antibiotic administration and dressing for about 2 weeks. Decreased sensation of the distal phalanx occurred in one case, and there was one case of non-union where we performed revision with an autogenous bone graft. In one case metatarsal joint subluxation occurred due to angular deformity, for which corrective osteotomy was performed. @*Conclusion@#Satisfactory results were obtained after distraction osteoplasty using external fixation for the treatment of the fourth brachymetatarsia.