Percutaneous osteotomy, regimented lengthening 'highly effective' for treating short metatarsals

NICE — Congenitally short metatarsals is often associated with an abnormal gait and an awkward appearance, but a group of orthopedic surgeons said that performing metatarsal lengthening using the callotasis method can help alleviate these problems in many patients, especially young women.

Surgeons examined and performed bone lengthening surgery in 13 female and 2 male patients. The surgeons performed these procedures on 12 metatarsals in eight patients, four metacarpals and one metatarsal in a single patient, one metacarpal and one metatarsal in another patient, and in seven metacarpals in each of five patients.

The mean age of the patients who underwent metacarpal procedures was 14.5 years, while the mean age of those who underwent metatarsal procedures was 17.5 years.

"We used the callotasis method for these procedures and we used either a unilateral external fixator and/or a circular external fixator," said Mehmet Erdem, MD, who presented the findings at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress, here.

The mean healing index and increase in metacarpal length was 1.6 months/cm and 17.6 mm, respectively. The mean follow-up period for patients who underwent metacarpal lengthening was 57.5 months, according to the abstract.

The mean healing index and increase in metatarsal length was 1.6 months/cm and 24.3 mm, respectively. The mean follow-up period for patients who underwent metatarsal lengthening was 48.3 months, and the preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were good in five cases and excellent in nine cases, Erdem said.

The functional scores of the metatarsophalangeal joint of lengthened metatarsals for the lesser toe were excellent in 12 cases and good in two cases based on the AOFAS scoring system. "All patients who underwent metacarpal lengthening reported that they were satisfied and could conduct their daily activities with good functional and aesthetic results," Erdem said.

Complications included four angulations, one subluxation and one nonunion.

"We conclude that this approach is highly effective for these patients," Erdem said. Most importantly, "The periosteum must be protected with percutaneus osteotomy, and lengthening should be performed at a rate of 0.25 mm twice a day, not exceeding 40% of the original bone length," or more than 20 mm.

For more information:
Erdem M, Sen C, Eralp L, et al. Lengthening of short bones by distraction osteogenesis: results and complications. Paper F311. Presented at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 29-June 1, 2008, Nice.