Metatarsal lengthening by distraction osteogenesis for brachymetatarsia in paediatric patients: is it safe and effective?

PURPOSE: The primary aim is to assess the efficacy of the surgical callus distraction technique of the metatarsus in paediatric patients. Secondary objectives are to assess complications and treatment duration. We have also described the details of our surgical technique. MATERIALS AND METHODS: A case series review of paediatric patients who had metatarsal lengthening at our unit between 2014 and 2022. Patient demographics, duration of time in frame, complications and metatarsal length achieved were recorded. The AOFAS Midfoot and the MOXFQ were taken pre-operatively and at final follow-up. RESULTS: Sixteen metatarsals in 8 patients (14 feet) underwent lengthening between 2014 and 2022 using the MiniRail OrthoFix 100 (Orthofix Medical Inc, Lewisville, TX, USA). The mean age was 13.3 (12-17) years. The average duration between surgery and implant removal was 5.2 months. According to Paley's classification, there was one obstacle encountered in a patient who required a revision of their osteotomy and one problem in another patient who had an infected metatarsophalangeal joint stabilising k-wire treated with oral antibiotics. The Mean AOFAS Midfoot score improved from 53.10 to 86.40 (p < 0.0001) and the Mean MOXFQ improved from 32.5000 to 12.1250 (p < 0.05); these were statistically significant. CONCLUSION: Gradual metatarsal lengthening using the MiniRail external fixator is a safe and effective method to treat brachymetatarsia in paediatric patients. This preliminary report describes and supports metatarsal lengthening in appropriate patients. Holistic care in terms of a pre-operative assessment, psychological support and preparation for the extended rehabilitation period are vital.

Fracture characteristics and outcomes of acetabular fracture management with minimally invasive approach and percutaneous fixation.

PURPOSE: The aim was to assess acetabular fracture outcomes of percutaneous fixation (PF) with or without minimally invasive surgery (MIS). METHODS: Between July 2011 and October 2016, acetabular fractures fixed with PF with or without MIS were included. Data collected are demographics, mechanism of injury, associated injuries, time to surgery, American Society of Anesthesiologists grade, fracture characteristics, surgical techniques, fracture reduction, secondary osteoarthritis (OA), revision surgery, patient survival and complications. RESULTS: Of 26 patients with a mean age of 56 years (19-86) (22 males and 4 females), 11 were < 50 years age (U50) and 15 were > 50 years (A50). Most common pattern was anterior column with posterior hemi-transverse. Three out of 11 U50 were minimally displaced and had PF only; the rest had MIS and PF. All had good fracture reduction, but 2 had secondary OA at follow-up but no further surgery. Eight out of 26 had secondary OA but only 3 needed surgery. Three (A50 with PF) with fair/poor reduction (deemed unfit for open reduction) had secondary OA but no further intervention. Three more (A50 with MIS + PF) had secondary OA treated with primary total hip replacement (THR). Complications were as follows: one foot drop recovered after immediate repositioning of screw, one cardiac event and one pulmonary embolism. CONCLUSION: Fracture mal-reduction predicts secondary OA, but good fracture reduction does not prevent secondary OA. MIS and PF in elderly are useful even with suboptimal reduction as it sets the bed for a non-complex THR. Despite MIS surgery, medical complications are potentially significant.