Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience
BACKGROUND:Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distracti...
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| Veröffentlicht in: | Journal of pediatric orthopaedics 2016-09, Vol.36 (6), p.582-588 |
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| container_title | Journal of pediatric orthopaedics |
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| creator | Calis, Mert Oznur, Ali Ekin, Omer Vargel, Ibrahim |
| description | BACKGROUND:Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.
METHODS:This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.
RESULTS:Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P |
| doi_str_mv | 10.1097/BPO.0000000000000503 |
| format | Article |
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METHODS:This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.
RESULTS:Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).
CONCLUSIONS:Anatomic features of Apert foot may lead to complaints that may limit patients’ daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.
LEVEL OF EVIDENCE:Level IV.</description><identifier>ISSN: 0271-6798</identifier><identifier>EISSN: 1539-2570</identifier><identifier>DOI: 10.1097/BPO.0000000000000503</identifier><identifier>PMID: 25929771</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Acrocephalosyndactylia - complications ; Acrocephalosyndactylia - diagnosis ; Acrocephalosyndactylia - physiopathology ; Acrocephalosyndactylia - surgery ; Activities of Daily Living ; Arthrometry, Articular - methods ; Child ; Child, Preschool ; Female ; Gait ; Humans ; Leg Length Inequality - etiology ; Leg Length Inequality - physiopathology ; Male ; Metatarsal Bones - diagnostic imaging ; Osteogenesis, Distraction - adverse effects ; Osteogenesis, Distraction - methods ; Outcome and Process Assessment (Health Care) ; Range of Motion, Articular ; Reoperation - methods ; Reoperation - statistics & numerical data ; Retrospective Studies ; Turkey</subject><ispartof>Journal of pediatric orthopaedics, 2016-09, Vol.36 (6), p.582-588</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3563-58b3fa1b01bdeb6a882699e941d91371fdb4912c0c9e3b9fbe937875b2578d963</citedby><cites>FETCH-LOGICAL-c3563-58b3fa1b01bdeb6a882699e941d91371fdb4912c0c9e3b9fbe937875b2578d963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25929771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calis, Mert</creatorcontrib><creatorcontrib>Oznur, Ali</creatorcontrib><creatorcontrib>Ekin, Omer</creatorcontrib><creatorcontrib>Vargel, Ibrahim</creatorcontrib><title>Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience</title><title>Journal of pediatric orthopaedics</title><addtitle>J Pediatr Orthop</addtitle><description>BACKGROUND:Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.
METHODS:This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.
RESULTS:Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).
CONCLUSIONS:Anatomic features of Apert foot may lead to complaints that may limit patients’ daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.
LEVEL OF EVIDENCE:Level IV.</description><subject>Acrocephalosyndactylia - complications</subject><subject>Acrocephalosyndactylia - diagnosis</subject><subject>Acrocephalosyndactylia - physiopathology</subject><subject>Acrocephalosyndactylia - surgery</subject><subject>Activities of Daily Living</subject><subject>Arthrometry, Articular - methods</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Gait</subject><subject>Humans</subject><subject>Leg Length Inequality - etiology</subject><subject>Leg Length Inequality - physiopathology</subject><subject>Male</subject><subject>Metatarsal Bones - diagnostic imaging</subject><subject>Osteogenesis, Distraction - adverse effects</subject><subject>Osteogenesis, Distraction - methods</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Range of Motion, Articular</subject><subject>Reoperation - methods</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Turkey</subject><issn>0271-6798</issn><issn>1539-2570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFO20AQhleIqklp3wChPfbisOONvd7ekkCgUlBQlR56snbtcbLgeMPuumleo0-MQwAhDsxlRqPv_0ean5BTYANgUpyPb-cD9rYSxo9IHxIuozgR7Jj0WSwgSoXMeuSL93eMgeBD_pn04kTGUgjok_8T6xwWwdiG2oqOnSpWuzUGFZTzRlHVlPQGS6NqOmqWba1eyLBCeuVQBbqwuF-MNugCnVob6HhHL4wPndcTPfcB7RIb9Mb_oCP6C_8a3O41gv7B7s5-vPzX6Q02BX4lnypVe_z23E_I7-nlYnIdzeZXPyejWVTwJOVRkmleKdAMdIk6VVkWp1KiHEIpgQuoSj2UEBeskMi1rDRKLjKR6O45WSlTfkK-H3w3zj606EO-Nr7AulYN2tbnkAHEkglgHTo8oIWz3jus8o0za-V2ObB8n0bepZG_T6OTnT1faPUay1fRy_s7IDsAW1sHdP6-brfo8hWqOqw-9n4EOQCWew</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Calis, Mert</creator><creator>Oznur, Ali</creator><creator>Ekin, Omer</creator><creator>Vargel, Ibrahim</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience</title><author>Calis, Mert ; Oznur, Ali ; Ekin, Omer ; Vargel, Ibrahim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3563-58b3fa1b01bdeb6a882699e941d91371fdb4912c0c9e3b9fbe937875b2578d963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acrocephalosyndactylia - complications</topic><topic>Acrocephalosyndactylia - diagnosis</topic><topic>Acrocephalosyndactylia - physiopathology</topic><topic>Acrocephalosyndactylia - surgery</topic><topic>Activities of Daily Living</topic><topic>Arthrometry, Articular - methods</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Gait</topic><topic>Humans</topic><topic>Leg Length Inequality - etiology</topic><topic>Leg Length Inequality - physiopathology</topic><topic>Male</topic><topic>Metatarsal Bones - diagnostic imaging</topic><topic>Osteogenesis, Distraction - adverse effects</topic><topic>Osteogenesis, Distraction - methods</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Range of Motion, Articular</topic><topic>Reoperation - methods</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Turkey</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calis, Mert</creatorcontrib><creatorcontrib>Oznur, Ali</creatorcontrib><creatorcontrib>Ekin, Omer</creatorcontrib><creatorcontrib>Vargel, Ibrahim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calis, Mert</au><au>Oznur, Ali</au><au>Ekin, Omer</au><au>Vargel, Ibrahim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience</atitle><jtitle>Journal of pediatric orthopaedics</jtitle><addtitle>J Pediatr Orthop</addtitle><date>2016-09</date><risdate>2016</risdate><volume>36</volume><issue>6</issue><spage>582</spage><epage>588</epage><pages>582-588</pages><issn>0271-6798</issn><eissn>1539-2570</eissn><abstract>BACKGROUND:Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.
METHODS:This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.
RESULTS:Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).
CONCLUSIONS:Anatomic features of Apert foot may lead to complaints that may limit patients’ daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.
LEVEL OF EVIDENCE:Level IV.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>25929771</pmid><doi>10.1097/BPO.0000000000000503</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 0271-6798 |
| ispartof | Journal of pediatric orthopaedics, 2016-09, Vol.36 (6), p.582-588 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acrocephalosyndactylia - complications Acrocephalosyndactylia - diagnosis Acrocephalosyndactylia - physiopathology Acrocephalosyndactylia - surgery Activities of Daily Living Arthrometry, Articular - methods Child Child, Preschool Female Gait Humans Leg Length Inequality - etiology Leg Length Inequality - physiopathology Male Metatarsal Bones - diagnostic imaging Osteogenesis, Distraction - adverse effects Osteogenesis, Distraction - methods Outcome and Process Assessment (Health Care) Range of Motion, Articular Reoperation - methods Reoperation - statistics & numerical data Retrospective Studies Turkey |
| title | Correction of Brachymetatarsia and Medial Angulation of the Great Toe of Apert Foot By Distraction Osteogenesis: A Review of 7 Years of Experience |
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