• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.197-201
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• 2012

Callotasis has been widely used to treat brachymetatarsia. But various complications have been reported. Avascular necrosis of the $4^{th}$ brachymetatarsia treated by callotasis has not been frequently addressed in the literature. We report 1 cases of avascular necrosis of the $4^{th}$ brachymetatarsia treated by callotasis with a review of the literature.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.13-20
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• 2003

Purpose: We analysis the outcome and complications of treatment of lesser toe brachymetatarsia. Materials and Methods: We analysed 28 patients 35 cases of lesser toe brachymetatarsia. Mean post operative follow up period was 2 years 8 months. All of the patients were female and mean age at operation was 21 years old. 2 cases of third metatasal bone and 33 cases of fourth metatarsal bone were operated. 8 metatarsal bones were treated using one staged lengthening with tricortical bone graft and 27 metatarsal bones were treated using callotasis with monofixator. Results: The average amount of lengthening was 13.3mm(12mm-15mm) in one staged lengthening, while 14.4mm(4mm-23mm) in callotasis. Average percentile increase was 28.9%(26%-34%) in one staged lengthening and 32%(18%-46%) in callotasis. The average healing index of callotasis was 76 days/cm (41 days/cm-166 days/cm). Satisfied outcomes in 4 cases of 8 cases (50%) after one staged lengthening and 17 cases of 27 cases (63%) after callotasis. 6 complications in 4 cases were occurred after one staged lengthening; insufficient length gain in 3 cases, fracture on the junction of graft bone and metatarsal bone in 1 case, plantar bowing deformity in 1 case and bony fusion of metatarsophalangeal joint in 1 case. 17 complications in 10 patients were occurred after callotasis ; metatarsophalangeal joint stiffness in 8 cases, metatarsophalangeal joint subluxation in 2 cases, overlengthened metatarsal bone in 2 cases, tapering of callus in 1 case, fracture of callus in 1 case, premature consolidation of callus in 1 case, osteomyelitis of metataral head in 1 case and plantar bowing deformity in 1 case. Conclusion: Although one staged lengthening and gradual lengthening using callotasis are effective treatment for lesser toe brachymetatarsia, complications not rarely occured after lengthening. Insufficient lengthening are most common complication after one staged lengthening while metatarsophalangeal joint stiffness lire most common complication after callotasis.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.73-79
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• 2002

Purpose: To evaluate the effectiveness of callotasis using the external fixator for the treatment of brachymetatarsia. Materials and Methods: Eleven patients(15 cases) who underwent callotasis were available. Follow-up averaged 23 months(15-38 months). Both the patients' postoperative satisfaction and the postoperative radiographic results were retrospectively evaluated. Results: The duration from applying the external fixator to remove averaged 15 weeks (8-21 weeks). We did osteotomy again in two cases because of early consolidation at the osteotomy site during distraction period. All cases were evaluated mild claw toe deformity and motional pain in metatarsophalangeal joint, but all patients satisfied the postoperative results except one complained motional pain and stiffness in metatarsophalangeal joint. The metatarsal shortening averaged 13mm(9-18mm) before operation. The amount of distraction for shortened metatarsals averaged 15mm(5-22mm). We found the 6 cases of narrowing of the metatarsophalangeal joint, 2 cases of subluxation of the metatarsophalangeal joint. Conclusion: We think that callotasis with external fixator is good operative method for the brachymetatarsia.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.33-39
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• 1999

Brachymetatarsia of the first metatarsal is uncommon. It may occur as a congenital condition. Hallux varus is the name given to a medially deviated position of the first metatarsophalangeal joint with a nonpurchasing hallux in varus position. To have a patient with not only both hallux varus and brachymetatarsia, but for the brachymetatarsia to occur about the first metatarsal, is extremly rare. We experienced a case of the brachymetatarsia of the first metatarsal with hallux varus treated by callotasis. Excellent cosmetical and funtional outcome were obtained. So we reporting the case with a review of the literatures.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.140-145
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• 2005

Purpose: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. Materials and Methods: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. Results: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. Conclusion: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2002.05a
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• pp.158-161
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• 2002

We investigated whether controlled dynamization enhanced regenerative bone healing of the tibia in 12 adult mongrel dogs. An average of 2 cm (∼ 10% of bone length) lengthening was obtained. The left hindlimb was allowed dynamization of 1 mm, 2 mm, and 3 mm in magnitude when 1 cm (∼ 5%) of lengthening was achieved, whereas the right hindlimb was not dynamized and served as a control. Bone mineral density (BMD) of the regenerative bone was measured periodically until nine weeks after the end of distraction. After sacrifice, uniaxial compression testing was performed. Relative BMD ratio and

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.186-189
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• 2010

Among congenital brachymetatarsias fourth metatarsal bone shortening is most common form and unusually involves multiple metatarsal bones. We report a case of the patient with bilateral 1st and 4th multiple rays brachymetatarsia treated with callostasis. Twenty eight months after procedure, right side showed 1st metatarsal lengthening about 11.5 mm (29.23%) and 4th metatarsal 17.86 mm (35.87%). Twenty one months later, left side showed 1st metatarsal lengthening about 14.58 mm (36.8%) and 4th metatarsal 20.52 mm (43.01%). In healing index right side showed 1st metatarsal 3.4 month/cm, 4th metatarsal 2.5 month/cm and left side showed 1st metatarsal 4.2 month/cm, 4th metatarsal 2.3 month/cm. Final follow-up results presented excellent outcome in cosmetic problem, easy wear of shoes, and measurement of patient's self satisfaction.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.50-56
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• 2005

There are limited treatment options in the reconstruction of the very large defect in the metaphyseal portion of distal femur and proximal tibia. Fibula is one of the most popular donor of the long bone reconstruction in reconstructive microsurgical field. It has many advantages such as very strong strut tubular bone, very reliable vascular anatomy with large vascular diameter and long pedicle. There are limited donor site problems such as transient peroneal nerve dysfunction. In those situations with the huge long bone defects in distal femur or proximal tibia, the defective bony shape and strength of the transplanted fibular bone is not enough if only one strut of the fibula is transferred. We performed 7 cases of "doule barrel" fibular transplantation on the metaphyseal portion of distal femur and proximal tibial large defects in which it is very difficult to fill the bony gap with conventional bone graft or callotasis methods. It takes averaged 8.3 months since that procedure to obtain bony union. After solid union of the transferred double barrelled fibular graft. There were no stress fracture in our series. So we can propose double barrel fibular graft is useful method in those cases with very large bone defect on the metaphysis of large long bone.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.182-185
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• 2010

19 years old girl presented with bilateral 1, 4th brachymetatarsia. We have used an autograft interposition technique to lengthen the brachymetatarsia involving first and fourth metatarsal. The technique was to graft the bone fragment from the relatively long second and third metatarsal bone to be used as an autograft to the short first and fourth metatarsal bone. The method is superior in not having the necessity of a long term external fixator which is needed using callotasis method and in also avoiding the inconvenience of performing an allograft. Absence of donor site complication during autograft from iliac bone is also an advantage to be mentioned. Our technique can therefore be ascertained as a successful method in both cosmetic results and improvement of symptoms including reduction in length of recovery.