• 1

    Choi HI, Chung MS, Baek GH, et al: Metatarsal lengthening in congenital brachymetatarsia: one stage lengthening versus lengthening by callotasis. .J Pediatr Orthop 19::660. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Fox IM: Treatment of brachymetatarsia by the callus distraction method. .J Foot Ankle Surg 37::391. ,1998. .

  • 3

    Oh CW, Sharma R, Song HR, et al: Complications of distraction osteogenesis in short fourth metatarsals. .J Pediatr Orthop 23::484. ,2003. .

  • 4

    Masada K, Fujita S, Fuji T, et al: Complications following metatarsal lengthening by callus distraction for brachymetatarsia. .J Pediatr Orthop 19::394. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Mahan K: Bone graft reconstruction of a flail digit. .JAPMA 82::264. ,1992. .

  • 6

    Skirving AP, Newman JH: Elongation of the first metatarsal. .J Pediatr Orthop 3::508. ,1983. .

  • 7

    Takakura Y, Tanaka Y, Fuju T, et al: Lengthening of short great toes by callus distraction. .J Bone Joint Surg Br 79::955. ,1997. .

  • 8

    Wakisaku T, Yasui N, Kujimoto H, et al: A case of short metatarsal bones lengthened by callus distraction. .Act Orthop Scand 59::194. ,1988. .

    • Search Google Scholar
    • Export Citation
  • 9

    Levine SE, Davidson RS, Dorman JP, et al: Distraction osteogenesis for congenitally short lesser metatarsals. .Foot Ankle Int 16::196. ,1995. .

  • 10

    Ilizarov GA: Clinical application of the tension-stress effect for limb lengthening. .Clin Orthop 250::81. ,1990. .

  • 11

    Magnan B, Bragantini A, Regis D, et al: Metatarsal lengthening by callotasis during the growth phase. .J Bone Joint Surg Br 77::602. ,1995. .

  • 12

    Boike A, Gerber M, Snyder A: Brachymetatarsia: axial lengthening by using callus distraction technique. .JAPMA 83::373. ,1993. .

  • 13

    Martin D, Stran D, Southerland J, et al: Callus distraction in reconstructive foot surgery. .J Foot Ankle Surg 35::489. ,1996. .

  • 14

    Ilizarov G: The tension-stress effect on the genesis and growth of tissues: part II. The influence and the rate and frequency of distraction. .Clin Orthop Relat Res (Feb):263. ,1989. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Complications Associated with Distraction Osteogenesis for the Correction of Brachymetatarsia

A Review of Five Procedures

Peter M. Wilusz Department of Surgery, Southeast Michigan Surgical Hospital, Warren, MI.

Search for other papers by Peter M. Wilusz in
Current site
Google Scholar
PubMed
Close
 DPM
,
Phi Van Department of Podiatry, Siena Medical Clinic, Garden City, KS.

Search for other papers by Phi Van in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Guy R. Pupp Department of Surgery, Kern Hospital Clinic, Warren, MI.

Search for other papers by Guy R. Pupp in
Current site
Google Scholar
PubMed
Close
 DPM
Restricted access

Background: Congenital brachymetatarsia is often treated with callus distraction. This technique is associated with a variety of complications. We investigated complications encountered in treatment of brachymetatarsia in four female patients and reviewed adjunctive procedures performed to treat these complications.

Methods: We reviewed five distraction osteogenesis procedures performed in four female patients with congenital shortening of the fourth metatarsal over a 3-year period. Serial radiographs were obtained weekly until bone consolidation was achieved, at which time the external fixator was removed. Follow-up ranged from 5 to 10 months.

Results: Three patients (four metatarsals) were satisfied with the cosmetic and functional outcomes of their procedure. One patient was dissatisfied with the cosmetic result owing to a short digit from a short proximal phalanx but was completely functional and resumed all of her normal activities. Complications associated with callus distraction were decreased range of motion and stiffness at the metatarsophalangeal joint, flexion deformity of the digit, angulation of the metatarsal, prolonged distraction time due to pain, fracture of the bone callus, pin-site infection, and an undesirable cosmetic appearance due to a short proximal phalanx. Adjunctive procedures were needed in some of these cases and yielded good results.

Conclusions: Callus distraction is an effective treatment for congenital shortening of the fourth metatarsal, but the procedure is associated with a number of complications. Because most patients proceed with surgery for cosmetic reasons, it is important to present the possible complications and the adjunctive surgical procedures that may be necessary for a desirable outcome. (J Am Podiatr Med Assoc 97(3): 189–194, 2007)

Corresponding author: Peter M. Wilusz, DPM, Department of Surgery, Southeast Michigan Surgical Hospital, 21230 Dequindre, Warren, MI 48091.