brachymetatarsia

[sinustarsi]

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If you have 2.5 cm shorthining of the 4th metatarsal, can you bone graft for brachymet with out n/v complications? What if the pt does not want the mini-fix? whats the guide line or cut-off for bone graft? Lengthening the met. with lamina spreader gradually intra-op with v-y skin plasty and the z lengthening of tendons etc. with bone graft. What do you guys think?

 

[Feli]

http://www.jbjs.org.uk/cgi/reprint/80-B/6/1040.pdf

1cm to 1.5cm is generally regarded as the upper safety limit for a single stage lengthening, but it's all variable based on pt, deformity, etc.

 

[NatCh]

I think the following article states that there is an increase in complications when you lengthen the bone greater than 40% of the original length:

http://journals.lww.com/pedorthopae.../Metatarsal_Lengthening_in_Congenital.21.aspx

I don't have a subscription to this journal otherwise I'd post it. Perhaps one of the Residents has easy access?

Edit: attached JAPMA article

"In 1995, Magnan30 reported that the amount of
lengthening should not exceed 50% of the preoperative
length when using callus distraction. However,
recent studies with callus distraction show the overall
length of the metatarsal should not exceed 40% of
the preoperative length to prevent joint stiffness,
neurovascular compromise, subluxation, or axial deviation
of the digit.30 In 1995, Masuda et al11 reported
on two cases of callus distraction in which greater
than 40% of the preoperative length was obtained
and a significant decrease in the range of motion at
the metatarsophalangeal joint was noted. In one stage
lengthening, the average length gained was approximately
30% with minimal complications. Choi et
al35 retrospectively reviewed the outcomes of both
one-stage lengthening and callus distraction and reported
the average percent increases to be 30.8% and
39.1%, respectively."