Treatment of Complications after Distraction Osteogenesis for Brachymetatarsia of the Fourth Metatarsal.

Brachymetatarsia is a congenital or acquired condition that most frequently involves the fourth metatarsal.1 Several surgical options are available for treating brachymetatarsia. Gradual lengthening of the metatarsals is a technique that is becoming increasingly popular, especially when more than 10 mm of metatarsal lengthening is needed.2–4 Skirving and Newman5 first reported on the use of gradual metatarsal lengthening. However, several reports have described the complications of distraction osteogenesis, including digital contracture, pin site infection, scars, and loss of length of the regenerated bone.3,4 Among these, refracture is a major complication after removal of the distractor. Most often, loss of the regenerated bone causes the refracture.4 Several methods have been described to prevent the loss of the regenerated bone, such as increasing the rate of lengthening, increasing the consolidation period, and using a reverse distraction technique.4 However, very few studies have investigated methods of recovering the lost regenerated bone. In the case reported here, the patient showed an hourglass-shaped regenerated bone after gradual fourth metatarsal lengthening. To prevent a refracture, we grafted a bioabsorbable hydroxyapatite and collagen complex, which ensured regeneration and prevented a refracture.