Zhu David, Lefèvre Maxime, Fernandez Andréa, Galois Laurent
Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France.
Case Rep Orthop. 2022 Mar 10;2022:8253096. doi: 10.1155/2022/8253096. eCollection 2022.
Brachymetatarsia is defined by an abnormal shortening of the metatarsal bone. This rare condition is mostly primary and congenital. Consequences of this malformation are both esthetic and functional, due to pain and mechanical problems in the forefoot. Surgical management is an important part of patient care. There are two main options: gradual lengthening by progressive callotosis distraction using an external fixator and one stage lengthening using bone graft and osteotomy of the bone. This review presents two cases using the one stage lengthening surgical management method. We also discuss some reports in the literature with the aim to compare the advantages and disadvantages of the two surgical methods. Literature concerning the surgical management of brachymetatarsia was identified using the PubMed and Google Scholar databases. . We describe two female patients aged 20 and 26 years who underwent one stage lengthening surgery of the fourth toe with isolated brachymetatarsia using an iliac bone graft and internal fixator plate. The two patients had a lengthening of around 10 mm after postoperative evaluation. No skin complications were noted, but one of the patients reported flexor stiffness after surgery. Concerning the functional and cosmetic aspects, the two patients are satisfied with the management.
In the literature, one stage lengthening seems to be the most favorable option for the care of brachymetatarsia. Studies show a short healing time and fewer complications like infection, stiffness, malalignment, and malunion. Some reviews note the utility of the gradual lengthening of severe brachymetatarsia when a longer lengthening is necessary. There is no definite consensus concerning the management of brachymetatarsia.
短跖骨症的定义是跖骨异常缩短。这种罕见病症大多为原发性和先天性的。由于前足疼痛和机械问题，这种畸形的后果既有美观方面的，也有功能方面的。手术治疗是患者护理的重要组成部分。主要有两种选择：使用外固定器通过渐进性骨痂牵张进行逐步延长，以及使用骨移植和骨截骨术进行一期延长。本综述介绍了两例采用一期延长手术治疗方法的病例。我们还讨论了文献中的一些报道，旨在比较两种手术方法的优缺点。使用PubMed和谷歌学术数据库检索了有关短跖骨症手术治疗的文献。我们描述了两名年龄分别为20岁和26岁的女性患者，她们接受了使用髂骨移植和内固定板对孤立性短跖骨的第四趾进行一期延长手术。术后评估显示，两名患者均延长了约10毫米。未发现皮肤并发症，但其中一名患者术后报告有屈肌僵硬。在功能和美观方面，两名患者对治疗结果均感到满意。
在文献中，一期延长似乎是治疗短跖骨症最有利的选择。研究表明愈合时间短，感染、僵硬、对线不良和骨不连等并发症较少。一些综述指出，在需要更长延长长度时，对于严重短跖骨症采用逐步延长的方法是有用的。关于短跖骨症的治疗尚无明确共识。
