Waizy Hazibullah, Polzer Hans, Schikora Nils, Forth Andreas, Becker Felix, Stukenborg-Colsman Chrisitina, Yao Daiwei
Hessing Stiftung, Augsburg, Germany.
Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany.
Foot Ankle Spec. 2019 Aug;12(4):330-335. doi: 10.1177/1938640018803731. Epub 2018 Oct 3.
Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.
短跖骨症被定义为跖骨的病理性缩短，可导致前足的外观问题和疼痛。主要的手术治疗选择包括：延长截骨术、骨移植置入和骨痂牵张。通常，取自髂嵴的骨移植用于置入截骨术。文献中尚未描述从腓骨获取移植骨的手术技术。对5例患者的8只患有短跖骨症的足进行了回顾性评估。最短随访期为2年。通过背侧V/Y形皮肤切口，在跖骨上进行中央截骨术。从腓骨前部获取移植骨。将移植骨插入并用锁定钢板固定。还进行了额外的软组织手术。所有病例均实现了骨愈合。平均延长长度为9.01毫米（5.49至12.54毫米）。这相当于整个跖骨平均延长20.3%。患者满意度高，对外观效果的满意度也高。无术后并发症。IV跖趾关节的跖屈活动度术前减少了20%。所有患者术后均能踮脚站立。1例患者在体育活动后报告有轻微症状。由于其解剖结构，移植骨能适应第IV跖骨。正如我们的研究所显示，从腓骨远端获取移植骨不会导致功能受限。在伤口和骨愈合以及疼痛症状方面，该方法应被视为标准髂骨移植的替代方法。
