Metatarsal lengthening by distraction osteogenesis for brachymetatarsia in paediatric patients: is it safe and effective?

PURPOSE: The primary aim is to assess the efficacy of the surgical callus distraction technique of the metatarsus in paediatric patients. Secondary objectives are to assess complications and treatment duration. We have also described the details of our surgical technique. MATERIALS AND METHODS: A case series review of paediatric patients who had metatarsal lengthening at our unit between 2014 and 2022. Patient demographics, duration of time in frame, complications and metatarsal length achieved were recorded. The AOFAS Midfoot and the MOXFQ were taken pre-operatively and at final follow-up. RESULTS: Sixteen metatarsals in 8 patients (14 feet) underwent lengthening between 2014 and 2022 using the MiniRail OrthoFix 100 (Orthofix Medical Inc, Lewisville, TX, USA). The mean age was 13.3 (12-17) years. The average duration between surgery and implant removal was 5.2 months. According to Paley's classification, there was one obstacle encountered in a patient who required a revision of their osteotomy and one problem in another patient who had an infected metatarsophalangeal joint stabilising k-wire treated with oral antibiotics. The Mean AOFAS Midfoot score improved from 53.10 to 86.40 (p < 0.0001) and the Mean MOXFQ improved from 32.5000 to 12.1250 (p < 0.05); these were statistically significant. CONCLUSION: Gradual metatarsal lengthening using the MiniRail external fixator is a safe and effective method to treat brachymetatarsia in paediatric patients. This preliminary report describes and supports metatarsal lengthening in appropriate patients. Holistic care in terms of a pre-operative assessment, psychological support and preparation for the extended rehabilitation period are vital.

Mid-term follow-up results of gradual capitate lengthening for the treatment of stage IIIA Kienbock's disease.

PURPOSE: This study aimed to evaluate the mid-term radiological and clinical results of gradual lengthening of capitate for the treatment of stage IIIA Kienbock's disease. METHODS: We retrospectively reviewed nine patients (five females, four males) with Lichtman stage IIIA Kienbock's disease who underwent gradual capitate lengthening at our hospital. Their clinical (range of motion (ROM), grip strength, visual analogue scale (VAS) value for pain, and Mayo wrist score (MWS)) and radiological outcomes (in terms of progression of arthritis and carpal height ratio) at the last follow-up were compared to the preoperative values. RESULTS: The mean age of the nine patients was 30 years (range: 20-38 years). The mean follow-up period was 73.8 (60-83) months. The average grip strength increased from 14.3 kg preoperatively to 22.3 kg at the last follow-up. The mean MWS increased from 58.8 preoperatively to 79.4 postoperatively. The mean VAS values decreased from the preoperative values: from 1.9 to 0.36 at rest, from 3.75 to 1.6 during mild effort, and from 5.35 to 3 during severe effort. The average carpal height ratio changed from 0.38 preoperatively to 0.53 postoperatively. None of the patients had any arthritic changes in their wrists. CONCLUSION: Gradual lengthening of capitate offers satisfactory mid-term results for treating stage IIIA Kienbock's disease.

Lengthening of the ulna by callotasis in children with multiple hereditary exostoses: comparison of methods with and without internal fixation.

PURPOSE: The goal of this retrospective study was to compare the gradual lengthening of the ulna in children with multiple hereditary exostoses with and without an elastic intramedullary nail. METHODS: Between 1998 to 2018, the ulna was lengthened in 28 forearms in 21 patients (aged 7.1 to 16.6 years) using a monolateral external fixator when relative ulnar shortening exceeded 15 mm. In total, 16 forearms were lengthened with the external fixator (group I) and 12 forearms with the addition of an intramedullary elastic nail (group II). Subjective assessment of function, range of movement (ROM) of the wrist and elbow and complications were compared. Ulnar shortening, radial head dislocation, radial articular angle (RAA) and percentage of carpal slip and radial bowing were followed radiographically. The difference between the groups has been evaluated statistically. RESULTS: The function of the extremity improved partially in 81% of patients in group I and in 83% of patients in group II. ROM was not improved except for radial deviation. Radial head position did not change. The values in group II in comparison with group I are higher for gain of length and lower for bone lengthening index and for bone healing index. Carpal slip decreased insignificantly. The RAA and radial bowing decreased, the comparison of values between groups and age under and over ten years were not statistically significant. Complications were more common in group I. No permanent complications were noted. CONCLUSION: The addition of an intramedullary nail during the gradual ulnar lengthening improves the gain, bone healing index and rate of complications. LEVEL OF EVIDENCE: III.

Nonincisional Osteotomy for Gradual Lengthening by Callus Distraction for Congenital Brachymetatarsia.

Gradual lengthening by distraction osteogenesis is widely used for congenital brachymetatarsia. The usual presenting complaint is the patient's cosmetic appearance. Osteotomy is an integral element. A nonincisional surgical approach for osteotomy can reduce dorsal longitudinal scarring and help preserve the periosteal blood supply to the bone during surgical dissection. Between June 2003 and January 2019, we performed gradual lengthening by callus distraction with nonincisional osteotomy for congenital brachymetatarsia on 13 digits in 5 patients. All 5 patients were female, and their average age was 18 years old. The lengthened bones involved 3 first metatarsals, 2 third metatarsal, and 8 fourth metatarsal bones. The mean gain in length was 15.2 mm (10-21 mm). The mean duration of distraction was 36.2 days (30-48 days). The mean duration of consolidation was 62.8 days (28-103 days). The lengthened segment consolidated in all cases. One patient had early consolidation and did not wish to undergo further surgery. There were no cases of trouble due to drilling for osteotomy. All patients had a normal gait and were satisfied with the cosmetic results.

Posteromedial tibial deformity: Radiological evolution and treatment of the discrepancy. / Deformidad posteromedial de la tibia: evolución radiológica y tratamiento de la discrepancia.

INTRODUCTION: Postero-medial deformity (DMPT), unlike other congenital forms that affect the tibia, presents a good evolution spontaneously correcting the important misalignments that present at birth based on the classic orthopedic laws of Wolff and Hueter-Volkmann, leaving slight residual angulations and variable limb length discrepancy. MATERIAL AND METHODS: Authors carry out a retrospective review of cases diagnosed with DPMT, the evolution of the tibial angulation and the discrepancy in the length of fourteen patients (11 males and 3 females) followed and treated between the years 2003 and 2018. Seven of these were treated by callus distraction. We have considered: PA and lateral of the tibia and stand-up entire limbs x-ray during age growth, along with the clinical records of the patients. RESULTS: The medial diaphyseal radiological deformity of the newborn or neonatal period was 34° and the final 10°. The posterior deformity evolved from 46° to a final angulation of 11°. The physeal angulation in the initial AP projection was 34° and the end view was 8° and in the lateral projection from 44 to 6°. The mechanical axis of the limb was correcting towards a neutral axis in relation to the aforementioned physeal and diaphyseal correction in all cases except two. In five of the cases, although the mechanical axis was normal-aligned, at the tibial level it ran eccentrically and externally to the tibial cortex. The length relationship between the short tibia and the healthy tibia maintains a constant proportion throughout the growth of 89%, that is, the inhibition of growth is 11%. We observe that 80% of the discrepancy is found in the tibia and that the remaining 20% ??was exposed from the height of the tarsus. Two patients presented a traumatic and accidental diaphyseal fracture of the tibia. The difference in the length of the tibia was compensated to seven patients by callus distraction of 5.4cm using the callotasis method with a Healing Index of 34.5 days/cm. CONCLUSIONS: DPMT improves substantially during the first years of life. Joint alignment of the knee and ankle is achieved before the correction of diaphyseal deformity. The tibia length discrepancy increases with the growth of the child since there is an 11% growth inhibition that will cause a skeletal maturity discrepancy between 4-7cm. Callus distraction before skeletal maturity is the method chosen to compensate this discrepancy.

Braquimetacarpia: Alargamiento mediante callotasis con fijador externo. Reporte de caso / Brachymetacarpy: Lengthening by callotasis with external fixator. Case report

Introducción La braquimetacarpia es una falta de longitud normal de los metacarpianos. La causa puede deberse a un síndrome, puede ser adquirida a partir de enfermedades infantiles, o puede surgir de forma idiopática. La incidencia es inferior a 1 en 1000, y la tasa de ocurrencia en las mujeres es 5 veces mayor que en los hombres. Reporte de caso Paciente que consulta por 4° dedo de la mano izquierda+corto y dolor en AMCF del mismo dedo con limitación funcional. RX: Braquimetacarpia del 4° metacarpiano. Se realizó: alargamiento mediante callotasis con fijador externo monolateral tipo Orthofix. Resultados Obtuvimos un resultado favorable, con un alargamiento progresivo del metacarpiano de 15mm y con buen resultado funcional sin complicaciones a los 2 años posquirúrgicos. Discusión La corrección quirúrgica de la braquidactilia se realiza principalmente por razones estéticas. Se usan varios métodos para alargar los metacarpianos. Algunos autores recomiendan el alargamiento gradual mediante distracción, argumentando que con esta técnica es más posible, con alta tasa de éxito cosmético y baja tasa de complicaciones. Destacamos en la resolución de este caso, una cuidadosa planificación preoperatoria, montaje intraoperatorio seguro del fijador externo y el seguimiento postoperatorio estricto, son esenciales para evitar la aparición de complicaciones.

Background Brachymetacarpy is a lack of normal metacarpal length. The cause may be due to a syndrome, it can be acquired from childhood diseases, or it can arise idiopathically. The incidence is less than 1 in 1000, and the occurrence rate in women is 5 times higher than in men. Case report Patient who consulted for the 4th finger of the left hand short and pain in the left finger with functional limitation. RX: Brachymetacarpy of the 4th metacarpal. It was carried out: lengthening by callotasis with Orthofix-type monolateral external fixator. Results We obtained a favorable result, with a progressive lengthening of the metacarpal of 15mm and with a good functional result without complications at 2 postoperative years. Discussion Surgical correction of brachydactyly is performed primarily for cosmetic reasons. Various methods are used to lengthen the metacarpals. Some authors recommend gradual lengthening through distraction, arguing that this technique is more possible, with a high rate of cosmetic success and a low rate of complications. We emphasize in the resolution of this case, careful preoperative planning, safe intraoperative mounting of the external fixator and strict postoperative follow-up, are essential to avoid the appearance of complications.

Long-Term Donor-Site Morbidity After Free, Nonvascularized Toe Phalanx Transfer for Congenital Differences of the Hand.

PURPOSE: Toe phalanx transplantation is a well-established technique for addressing bony deficiency in the reconstruction of hypoplastic digits in patients with congenital differences of the hand. Prior studies have commented on varying degrees of donor-site morbidity, although assessment of morbidity with validated outcome scores is lacking. This study seeks to evaluate donor-site morbidity after toe phalanx harvest using validated outcome measures. METHODS: We identified all children who underwent free, nonvascularized toe phalanx transfer to the hand at our institution from 2001 to 2011. We administered the Oxford Ankle Foot Questionnaire for Children (OXAFQ-C) and the Foot and Ankle Ability Measure (FAAM) to all patients, scaling results according to published scoring instructions. RESULTS: Thirty-six patients with 83 toe phalanx transfers were able to be contacted, with a mean follow-up of 5.3 years (range, 18 months-11.2 years). The results of the OXAFQ-C showed mean scores of 99.96% (Physical), 100% (School and Play), and 96.01% (Emotional). The FAAM mean scores were 99.08% (Sports) and 99.17% (Activities of Daily Living). There were no lower extremity complications during the study period. CONCLUSIONS: In contrast to varying degrees of donor-site morbidity reported in the current literature, this study demonstrates that toe phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Long Term Result of Weil Osteotomy and Callotasis for Bilateral Brachymetatarsia: A Case Report.

INTRODUCTION: Brachymetatarsia can be treated by lengthening of the affected metatarsals or shortening of the normal neighboring metatarsals. Combination of the two methods may be more effective rather than using one skill due to less complications. CASE REPORT: A 56-year-old female patient with the bilateral first, fourth-ray brachymetatarsia underwent Weil osteotomy of the second, third, fifth metatarsals, and callotasis of the fourth metatarsal. Follow-up examination had been carried out since the surgery was done about 10 years ago. CONCLUSIONS: In the decade after observation, the patient was very satisfied with the shape and function of the feet, and no complications occurred.

[Endoprosthetic replacement following intercalary resection]. / Endoprothetische Rekonstruktion nach interkalarer Resektion.

BACKGROUND: Endoprosthetic replacement is a valuable treatment option following intercalary resection of bone tumours in the diaphysis. OBJECTIVES: To identify indication, operative technique, implants currently available, literature results and alternative procedures for the alloplastic reconstruction of segmental bone defects. MATERIALS AND METHODS: This review article summarizes the authors' own experiences and relevant clinical studies focussing on this topic. RESULTS: According to the literature, 10-year-survival rates of intercalary endoprostheses range between 64 and 80%. Yet, comparisons between different publications are difficult due to the limited number of cases, different implants, follow-up periods and the heterogeneous patient populations. Biological alternatives for reconstruction are autologous bone transplantation, distraction osteogenesis and bone transport, allogenic bone transplantation, and the induced membrane technique. Innovative tissue engineering approaches are still limited to preclinical testing. CONCLUSIONS: Short- to mid-term results for segmental endoprostheses following intercalary resections are satisfactory and may be regarded as superior to those of biological reconstructions due to the immediate full weight-bearing capability. However, they are mainly applied for elderly patients and in palliative situations because of potential long-term complications.

Remote-controlled internal lengthening plate for distraction osteogenesis in pediatric patients.

OBJECTIVES: Limb lengthening by distraction osteogenesis is a technique widely used to treat limb length discrepancy resulting from trauma, congenital limb defects and long bone non-union. For decades, patients have resorted to the Ilizarov apparatus, prone to pin tract infections and scarring. Although implantable lengthening nails have reduced the incidence of complications, they are not applicable in pediatric patients with open growth plates. The aim of this project is to design a remote-controlled internal lengthening device suitable for implantation in children. METHODS: The proposed device has the form of an internal remote-controlled telescopic lengthening plate, screwed to the lateral side of the bone with locking screws. This is appropriate for use with pediatric patients. It has been tested on an experimental bench which has the form of a vertically sliding platform, on which were stacked weights simulating soft-tissue resistance forces. RESULTS: This internal lengthening plate generated distraction forces of up to 735 N on wooden and synthetic bones (SawbonesTM). Furthermore, it maintained a constant distraction speed over the course of the procedure for a given weight. CONCLUSIONS: This device represents a major advancement in the field of pediatric limb-lengthening, addressing a demographic gap left open by current implantable devices.

Distraction Lengthening of First Metacarpal in Traumatic Thumb Amputations.

Introduction Based on the level of the thumb loss, phalangization, toe-to-thumb transfer, pollicization, and distraction callotasis of the first metacarpal are the various options available for reconstruction. The aims of the study were to observe the length gained in the distraction process, duration of treatment required, functional recovery in the form of pinch strength, sensations, and patient satisfaction. Patients and Methods It was a prospective study of 10 patients of thumb amputation, conducted from January 2014 to July 2015. The patients' age, mode of injury, level of amputation, and advantages and disadvantages of distraction callotasis were evaluated. Results The most common etiology of thumb loss was domestic accidents while working with a chaff cutter. The total duration of treatment was 124 (93-165) days and the mean gain in length was 25 (20-28) mm. The pinch strength increased from a mean of 0.91 to 2.06 kg, i.e., a 44.17% improvement from preoperative pinch strength. All of our patients retained their sensations of the reconstructed thumb post distraction. Conclusions Among many options for thumb reconstruction, distraction callotasis is a simple and safer option in the selective group of patients who are not keen on toe-to-thumb transfer which provide a significant improvement. The longer duration of treatment is the disadvantage associated with the need for proper counselling beforehand.

Femoral lengthening in children and adolescents.

Current lengthening techniques are still based on the Ilizarov method and the concept of callotasis. Research and progress in medical devices have led to constant improvement in results. Hexapod fixators allow more precise correction of complex deformities, with shorter learning curve. Associating lengthening by external fixation (EF) to internal fixation (K-wire, intramedullary nail or locking plate) has reduced EF times and complications rates, while improving anatomic and functional results. Lengthening nails provides faster recovery of range of motion and return to activity during lengthening and consolidation, with better psychological tolerance. Lengthening with deformity correction by retrograde nailing has no impact on consolidation. Monolateral EF is a reliable and easy-to-implement technique that is well tolerated by patients. Association to internal fixation gives promising results. Bone healing solidity assessment on plain X-ray is highly subjective, with wide inter- and intra-observer variation; bone mineralization is better assessed in terms of pixel-value ratio (PVR: ratio of pixel value of regenerate to adjacent bone) on picture archiving and communication system (PACS) digitized radiographs, providing objective assessment of callus solidity.

Metacarpal lengthening in children: comparison of three different techniques in 15 consecutive cases.

Metacarpal lengthening is a useful procedure to address hand deficiencies in children. In this study, we aimed to compare the results of three different techniques from one consecutive clinical series of hand deficiencies. A total of 15 metacarpal lengthenings have been performed in 12 children aged from 9 to 14 years. The callotasis technique was used in seven cases, the two-stage distraction-graft technique in four cases and the single-stage lengthening in four cases. All the metacarpals healed with bone. The lengthening obtained was a mean of 13 mm (range 8-21 mm), a mean of 22 mm (range 13-32 mm) and a mean of 12 mm (range 9-15 mm), respectively, in the three different techniques. The healing index was longer for callotasis (81 days/cm) compared with the other techniques (41 days/cm and 46 days/cm, respectively). We observed one case of fracture after callotasis and one after distraction-graft. One patient underwent tenolysis of the extensor mechanism after single-stage lengthening. In conclusion, distraction graft and single-stage lengthening may be valuable alternatives to callotasis. LEVEL OF EVIDENCE: IV; therapeutic study; multi-case series.

Bone elongation using monolateral external fixation: a practical guide.

In the literature, we can find many articles that describe in detail specific complex procedures related to the limb reconstruction. However, the general information on the biological and mechanical bases of callotasis is out of date, and the surgeons must relate to works dating from the early 1980s. These articles also come from a period in which the callotasis technique was being developed and, therefore, incur in discrepancies depending on the year they were written or the school of the author. This paper provides a general and summarised overview of the theoretical and practical aspects interesting to a surgeon that needs clear information on the bone elongations performed with the help of a monolateral external fixator.

Metacarpal Lengthening Of The Thumb Via Distraction Osteogenesis: A Case Report.

Amputation of the thumb invariably causes marked functional impairment of the hand especially, pinch and grasp functions. In rural areas where highly skilled microvascular surgeries are not available, distraction osteogenesis provides an easy and safe alternative of thumb reconstruction. We report a case of crush injury of the right hand in a 37 year old gentleman in which the right thumb was amputated at the level of the proximal phalanx. Metacarpal lengthening of the thumb was performed by using distraction osteogenesis.

Current concepts of leg lengthening.

Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames-built on hexapod strut-linked platform technology as known from flight simulators-took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient's deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

4th Metatarsal Head AVN Treated by Callotasis in 4th Brachymetatarsia (A Case Report) / 대한족부족관절학회지

Callotasis has been widely used to treat brachymetatarsia. But various complications have been reported. Avascular necrosis of the 4th brachymetatarsia treated by callotasis has not been frequently addressed in the literature. We report 1 cases of avascular necrosis of the 4th brachymetatarsia treated by callotasis with a review of the literature.

Bone lengthening osteogenesis, a combination of intramembranous and endochondral ossification: an experimental study in sheep.

We evaluated the morphological features of the newly formed tissue in an experimental model of tibial callotasis lengthening on 24 lambs, aged from 2 to 3 months at the time of operation. A unilateral external fixator prototype Monotube Triax(®) (Stryker Howmedica Osteonics, New Jersey) was applied to the left tibia. A percutaneous osteotomy was performed in a minimally traumatic manner using a chisel. Lengthening was started 7 days after surgery and was continued to 30 mm. The 24 animals were randomly divided into three groups of 8 animals each: in Group 1, lengthening took place at a rate of 1 mm/day for 30 days; in Group 2, at a rate of 2 mm/day for 15 days; in Group 3, at a rate of 3 mm/day for 10 days. In each group, 4 animals were killed 2 weeks after end of lengthening, and the other 4 animals at 4 weeks after end of lengthening. To assess bony formation in the distraction area, radiographs were taken every 2 weeks from the day of surgery. To study the process of vascularization, we used Spalteholz's technique. After killing, the tibia of each animal was harvested, and sections were stained with hematoxylin and eosin, Masson's trichrome, and Safranin-O. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II, S100 protein, and fibronectin. A combination of intramembranous and endochondral ossification occurred together at the site of distraction. Our study provides a detailed structural characterization of the newly formed tissue in an experimental model of tibial lengthening in sheep and may be useful for further investigations on callotasis.

Brachymetatarsia of the First Metatarsal treated by Callotasis / 대한족부족관절학회지

PURPOSE: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. MATERIALS AND METHODS: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. RESULTS: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. CONCLUSION: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.

Brachymetatarsia of the First Metatarsal treated by Callotasis / 대한족부족관절학회지

PURPOSE: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. MATERIALS AND METHODS: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. RESULTS: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. CONCLUSION: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.