1. Congenital Brachymetatarsia involving more than two metatarsals
: One-stage combined shortening and lengthening procedure without iliac bone graft
Moon Sang Chung, M.D., Goo Hyun Baek, M.D.,
Jin Sam Kim, M.D., and Pil Whan Yoon., M.D.,
Department of Orthopedic Surgery,
Seoul National University College of Medicine

2. Congenital Brachymetatarsia
Abnormal shortening of the metatarsal bone
caused by premature closure of the epiphysis
Female : Male = 98 : 4
Predominance in younger female patients
→ the goal of treatment focused on the good
cosmetic results

3. Congenital Brachymetatarsia
72% of the cases being bilateral
(Urano Y. et al, 1978)
The fourth toe is most commonly involved,
although any or multiple metatarsals may be
affected

4. One-stage Lengthening vs. Gradual Lengthening
1. One-stage lengthening with intercallary bone graft
Advantages Shorter period of bony union
- Lesser scar
Disadvantages Bone graft donor-site morbidity
- Neurovascular impairment
- Small length gain due to high tension

5. One-stage Lengthening vs. Gradual Lengthening
2. Gradual lengthening by callus distraction
Advantages - No need for bone grafting
- Easier tendon stretching
- Lesser neurovascular complication
- Early weight bearing
Disadvantages Joint stiffness, deformity
- Pin site scar, Pin-tract infection
- Longer period for bone consolidation
- Ugly postoperative scar

6. Patients and Method Jan, 1994 ~ Dec, 2000 5 cases
All female
Bilateral involvement
Congenital brachymetatarsia with 1st and one or two metatarsals
Mean age : 15.8 (10 ~ 26) years
Mean follow-up: 69.5 (29 ~ 107) months

7. Patients and Method Restoration of normal metatarsal parabola
Length gain (mm)
Percentage increase (%)

8. Patients and Method : equivalent to the time of solid bony union
4. Healing index (months/cm)
: equivalent to the time of solid bony union
Complications
Satisfaction of the patient

9. Operative Procedures
Modified one-stage combined lengthening and shortening technique
A dorsal lazy S skin incision was made over second web space
Two holes for wire fixation were made and 2nd and 3rd metatarsals were shortened

10. Operative Procedures One-stage lengthening technique of
gradual distraction at operation
The use of creep and stress
relaxation for between 20 and 30
minutes
No need for Z-plasty of the extensor
tendon or V-Y plasty of skin
No neurovascular problems
The osteotomy site at the 4th metatarsal midshaft was gradually distracted by bone spreader

11. Operative Procedures
The excisied bone was placed in the gap in the lengthened 4th metatarsal bone
Wound was closed and sterile strip were applied

12. Results Good functional metatarsal parabola was restored.
Mean length gain : 9.8 (5 to 12) mm
Mean percentage increase : 28.3 (19 to 57) %

13. Results 4. Healing index : 2.0 (1.6 to 3.8) months/cm
5. No complications
6. All were satisfied with the cosmetic results and could walk on tiptoe and had no limitation in the activities of daily life.

14. Results
Summary of the data of one-stage combined shortening and lengthening in 5 patients
Patients
Age
Sex
Involvement
Shortening
Lengthening
Length
gain (mm)
Percentage
increase (%)
Healing
Index
(mo/cm)
Case 1 14 F
Both 1st , 4th
Both 2nd,3rd MT
Both 4th MT
Rt : 11
Lt : 11
24%
2.1
Case 2 16
Both 1st , 4th , 5th
Rt 4th MT
Lt 4th PP
Rt ; 9
Lt : 8
19%
57%
2.2
2.5
Case 3 10
Lt : 10
27%
23%
1.6
1.8
Case 4 13
Both 2nd,3rd MT 5th PP
Both 4th MT,
Both 4th PP
Rt MT : 11
Lt MT : 11
Rt PP : 5
Lt PP : 8
22%
38%
1.7
3.8
2.4
Case 5 26
Rt : 12
21%

15. Case 1 (F/14)
Before operation
One year seven months after operation

16. Case (F/14) Before operation Immediately after operation
One year seven months after operation

17. Case 2 (F/16)
Before operation
Nine years after operation
Tip toeing

18. Discussion Modified one-stage combined lengthening
and shortening technique
Only one skin incision → Lesser scar
Shorter length to restore normal parabola
→ Lower the risk of neurovascular complication

19. Discussion Modified one-stage combined lengthening
and shortening technique
Bilateral operation → Symmetrical feet
Reduction feet size after operation

20. Conclusions Our modified one-stage combined lengthening and shortening
technique may be a good treatment of choice to correct bilateral
congenital brachymetatarsia.
All patients were satisfied with their feet cosmetically and
functionally without complications.