Kirienko A., Spreafico L.P., De Donato M., Sansone V.

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Kirienko A., Spreafico L.P., De Donato M.,
Sansone V.
DISTRACTION LENGTHENING OF THE LONG BONES OF THE
FOOT IN CHILDREN
Istituto Clinico Humanitas, Italy
www.kirienko.com
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Materials Methods 

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• 23 metatarsals and 3 phalanx of the hallux in 17
  patients (7? and 10?, mean age 13 4.5 years)
• 2 Bilateral shortening of 3rd and 4th
  metatarsals,
• 9 Brachymetatarsia of 4th metatarsal (three
  bilateral)
• 4 Post-traumatic
• 3 Congenital defect of 1st metatarsal
• 3 Stump of the proximal phalanx of the hallux.
• Surgery performend with Ilizarov mini-fixator for
  short tubular bones and semicircular mini-fixator

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Ilizarov minifixator for short tubular bones
Fixation Module
3\4 Threated rod
Nuts
Washers
K. wires
Bolts
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Methods

• Bone extremities fixation with 2 modules
• Percutaneous osteotomy
• Distraction after 5 days of surgery
• Early weight bearing
• Initial rate of lengthening of 0,75 mm per day,
  slowed to 0.5mm after 2 weeks.

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A 13-year-old Female With Turner Syndrom And
Bilateral Shortening Of The Fourth And Fifth
Metatarsal.
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during lengthening
Before lengthening
Radiograph after surgery
A 17-year-old Male With Congenital Shortening Of
The First Metatarsal.
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Results 

• Average length of 17,3 mm (range from 12 to 25
  mm)
• Equivalent increase of 36 (range 25-46)
• Mean healing index of 61 days/cm
• AOFAS average score for lesser toes of 85,3
  (range from 53 to 100) and 73 (range from 51 to
  93) for hallux.

• Complications
• 6 stiffness of MF joint
• 2 subluxation of MF joint
• 5 angular deviation of the lengthened bone
• 4 pin track infection
• 1 retard of consolidation after lengthening that
  needed new distraction bone transport

• No bone graft and neurovascular complications in
  all cases

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Conclusions

• This technique of gradual distraction permits
• sufficient precision lengthening for forming the
  physiological arch of metatarsals heads.
• contemporarily correction of deformities without
  bone grafting and soft tissue spearing.

Subluxation of MF joint prevented by pitting of
the toe with longitudinal K-wire.
Excellent clinical and functional results
obtained with both semicircular and Ilizarovs
mini-fixators.
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Conclusions

• We recommend this method as the way of choice for
  problem of metatarsal and phalanx shortening.
• Bone lengthening is effective in patients not
  only for aesthetics, but also to relieve pain and
  callosities on the plantar surface on the 2nd and
  3rd MT heads
• Prevent secondary deformities of toes nearby.