신연 골형성술을 이용한 제4 중족골 단축증의 치료결과

Abstract

Purpose: Brachymetatarsia is a relatively rare disease that can be diagnosed when there is a shortening of more than 5 mm from adjacent metatarsal bones. It may cause cosmetic complaints and functional disorders. The purpose of this study was to evaluate radiologic and clinical results after distraction osteogenesis using external fixator for fourth brachymetatarsia. Materials and Methods: From September 2005 to January 2018, 45 cases of brachymetatarsia who underwent distraction osteogenesis using external fixator and followed up for at least 6 months were studied retrospectively. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication, and the patients satisfaction was analyzed. The patients satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were scored according to the level of stiffness, pain, function, and alignment. Results: The average gain in length and the percentage increase in the fourth metatarsals were 13.7 mm and 129.9%, and the mean follow-up period was 14.2 months after removal of the external fixator. Bony union was obtained in the metatarsal bones of almost cases except 1 case of nonunion. According to the AOFAS score, 39 cases were excellent and 6 cases were good at the final follow-up. The patient showed satisfactory cosmetic and functional results. Complications were pin site infections in 3 cases, all improved by oral antibiotic administration and dressing for about 2 weeks. Decreased sensation of distal phalanx was occurred 1 case and there is a 1 nonunion case and we performed revision with autogenous bone graft. In one case metatarsal joint subluxation occurred due to angular deformity, so corrective osteotomy was performed. Conclusion: Satisfactory results were obtained after distraction osteoplasty using external fixation for the treatment of the fourth brachymetatarsia.