O3277: Gradual Lengthening of Adolescent Short Toes is Safe and Successful

Background: Adolescents with brachymetatarsia seek surgical treatment to improve the cosmetic appearance of their affected toes. Gradual metatarsal lengthening using an external fixator has been an established management option. However, many surgeons are reluctant to offer this procedure to their patients because of an expected high complication rate. This study aims to demonstrate that with the proper technique and postoperative management, metatarsal lengthening can be performed safely with satisfactory outcome. Details of the surgical technique and how to avoid and manage complications are presented.

Methods: Records of patients who underwent metatarsal lengthening using a uniplanar external fixation system by a single pediatric orthopedic surgeon is presented. Patients’ demographic data were recorded. Preoperative and postoperative radiographs were measured to record metatarsal head variance, distraction length, lengthening and consolidation time, and metatarsal angulation. Details of the preoperative consultation, surgical technique, and postoperative management are presented. Complications are reported with technical details on how to avoid and manage them.

Results: (Figures) A total of 17 patients (16 female) with 31 metatarsals (26 fourth and 5 third) were included. Average age at surgery was 15 (SD 2) years. Average follow up was 19 (SD 15) months. Average preoperative metatarsal head variance was 12 (SD 3) mm. Lengthening started at 0.75mm per day and slowed down to 0.5mm per day as needed. Average lengthening time was 49 (SD 11) days, while average time in frame was 124 (SD 20) days. Average metatarsal lengthening was 21 (SD 7) mm. Final metatarsal head variance was 4 (SD 5) mm, and final metatarsal shaft angulation was 21 (SD 12) degrees. There were 2 revision surgeries (6.5%), one for incomplete osteotomy, and one for a displaced pin following a fall. Complications included coronal metatarsal angulation, pin site infection, foot pain and weak push off after frame removal, ankle stiffness, and nonunion (Table 1). At the last follow up, all patients reported no pain with return to their baseline activities.

Conclusion: Gradual metatarsal lengthening using an external fixator is a safe, effective, and reasonable option to offer to adolescent patients with brachymetatarsia who choose to have it corrected. Detailed preoperative discussion, meticulous technique, and close postoperative management ensures a safe and satisfactory outcome.