Effectiveness analysis of metatarsal mortise and tenon shortening osteotomy in treatment of macrodactyly in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Dongmei ¹ , TIAN Guanglei ² ,  LI Dacun ¹ , ZHAO Min ¹ , ZHAO Liang ¹ , LIU Jingda ¹ , ZHANG Wentong ¹

1. Department of Hand and Foot Surgery, the Hospital of Shunyi District of Beijing, Beijing, 101300, P. R. China;
2. Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

LI Dacun, Email: 13039517279@163.com

Keywords：

Macrodactyly; metatarsal shortening; mortise and tenon osteotomy; children

DOI：

10.7507/1002-1892.202112066

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Objective To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children. Methods The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded. Results All 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred. Conclusion Metatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.

Citation： LI Dongmei, TIAN Guanglei, LI Dacun, ZHAO Min, ZHAO Liang, LIU Jingda, ZHANG Wentong. Effectiveness analysis of metatarsal mortise and tenon shortening osteotomy in treatment of macrodactyly in children. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 405-409. doi: 10.7507/1002-1892.202112066 Copy

1.	Rougereau G, Fitoussi F, Marty-Diloy T, et al. Strategy and clinical outcomes of child foot surgery for macrodactyly. Orthop Traumatol Surg Res, 2021. doi: 10.1016/j.otsr.2021.103109.
2.	Josh F, Soekamto TH, Faruk M, et al. Phalangectomy combination double-pedicled digital artery flap for second-toe macrodactyly reconstruction: A case report. Int J Surg Case Rep, 2021, 81: 105767. doi: 10.1016/j.ijscr.2021.105767.
3.	Alexander L, El Kazzaz AMH, Schenker M. Isolated acquired macrodactyly of the left fourth toe. Cureus, 2021, 13(1): e12648. doi: 10.7759/cureus.12648.
4.	顾玉东, 张高孟, 张丽银, 等. 先天性巨指症10例报道. 中华手外科杂志, 1998, 14(3): 137-138.
5.	贾和庚, 于风章. 先天性巨肢、巨指 (趾) 畸形20例报告. 北京医学, 1987, 9(5): 293, 295.
6.	赵俊会, 杨克非, 孟淑琴. 巨指症12例临床分析. 中华外科杂志, 1989, 27(4): 227.
7.	侯书健, 程国良, 方光荣, 等. 巨指症9例治疗体会. 实用手外科杂志, 2002, 16(3): 144-145.
8.	康皓, 洪光祥, 王发斌, 等. 先天性巨指畸形的临床治疗. 中华手外科杂志, 2007, 23(5): 261-262.
9.	王海华, 田光磊, 诸寅, 等. 巨趾畸形12例临床分析. 中华外科杂志, 2008, 46(6): 434-436.
10.	武竞衡, 田光磊, 赵俊会, 等. 73例巨指 (趾) 畸形患者临床疗效分析. 中华外科杂志, 2008, 6(7): 514-517.
11.	Mansur H, Maranho DA. Shortening scarf osteotomy for macrodactyly and valgus of the hallux in acrodysostosis lesser toes brachydactyly. Foot Ankle Spec, 2021, 14(2): 158-163.
12.	Gluck JS, Ezaki M. Surgical treatment of macrodactyly. J Hand Surg (Am), 2015, 40(7): 1461-1468.
13.	Ezaki1 M, Beckwith T, Oishi SN. Macrodactyly: decision-making and surgery timing. J Hand Surg (Eur), 2019, 44(1): 32-42.
14.	Stor MLE, Lokhorst MM, Horbach SER, et al. The long-term progression of macrodactyly. JPRAS Open, 2021, 31: 10-21.
15.	胥少汀, 葛宝丰, 徐印坎, 主编. 实用骨科学. 4 版 (上册). 北京: 人民军医出版社, 2012: 464.
16.	荣国威. 骨折. 北京: 人民卫生出版社, 2004: 1703-1705.

1. Rougereau G, Fitoussi F, Marty-Diloy T, et al. Strategy and clinical outcomes of child foot surgery for macrodactyly. Orthop Traumatol Surg Res, 2021. doi: 10.1016/j.otsr.2021.103109.
2. Josh F, Soekamto TH, Faruk M, et al. Phalangectomy combination double-pedicled digital artery flap for second-toe macrodactyly reconstruction: A case report. Int J Surg Case Rep, 2021, 81: 105767. doi: 10.1016/j.ijscr.2021.105767.
3. Alexander L, El Kazzaz AMH, Schenker M. Isolated acquired macrodactyly of the left fourth toe. Cureus, 2021, 13(1): e12648. doi: 10.7759/cureus.12648.
4. 顾玉东, 张高孟, 张丽银, 等. 先天性巨指症10例报道. 中华手外科杂志, 1998, 14(3): 137-138.
5. 贾和庚, 于风章. 先天性巨肢、巨指 (趾) 畸形20例报告. 北京医学, 1987, 9(5): 293, 295.
6. 赵俊会, 杨克非, 孟淑琴. 巨指症12例临床分析. 中华外科杂志, 1989, 27(4): 227.
7. 侯书健, 程国良, 方光荣, 等. 巨指症9例治疗体会. 实用手外科杂志, 2002, 16(3): 144-145.
8. 康皓, 洪光祥, 王发斌, 等. 先天性巨指畸形的临床治疗. 中华手外科杂志, 2007, 23(5): 261-262.
9. 王海华, 田光磊, 诸寅, 等. 巨趾畸形12例临床分析. 中华外科杂志, 2008, 46(6): 434-436.
10. 武竞衡, 田光磊, 赵俊会, 等. 73例巨指 (趾) 畸形患者临床疗效分析. 中华外科杂志, 2008, 6(7): 514-517.
11. Mansur H, Maranho DA. Shortening scarf osteotomy for macrodactyly and valgus of the hallux in acrodysostosis lesser toes brachydactyly. Foot Ankle Spec, 2021, 14(2): 158-163.
12. Gluck JS, Ezaki M. Surgical treatment of macrodactyly. J Hand Surg (Am), 2015, 40(7): 1461-1468.
13. Ezaki1 M, Beckwith T, Oishi SN. Macrodactyly: decision-making and surgery timing. J Hand Surg (Eur), 2019, 44(1): 32-42.
14. Stor MLE, Lokhorst MM, Horbach SER, et al. The long-term progression of macrodactyly. JPRAS Open, 2021, 31: 10-21.
15. 胥少汀, 葛宝丰, 徐印坎, 主编. 实用骨科学. 4 版 (上册). 北京: 人民军医出版社, 2012: 464.
16. 荣国威. 骨折. 北京: 人民卫生出版社, 2004: 1703-1705.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of metatarsal mortise and tenon shortening osteotomy in treatment of macrodactyly in children

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