Clinical study of Ilizarov technique combined with “joystick technique” in treatment of fourth brachymetatarsia_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Jiachang , FENG Enhui , GUAN Hua , CHEN Pu , HE Jianbo , HUANG Weiming , XU Yiyin ,  XIE Jiewei

Department of Trauma and Foot-Ankle Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong Guangzhou, 510120, P. R. China;

Corresponding?author：

XIE Jiewei, Email: gdszyycszhk@163.com

Keywords：

Fourth brachymetatarsia; Ilizarov technique; joystick technique; distraction osteogenesis

DOI：

10.7507/1002-1892.202604016

Video：

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Objective To evaluate the effectiveness and safety of Ilizarov technique combined with the “joystick technique” for the treatment of fourth brachymetatarsia. Methods A retrospective analysis was performed on 53 patients with fourth brachymetatarsia who met the selection criteria and were treated between August 2021 and January 2025. Patients were divided into two groups according to the surgical method: group A (Ilizarov combined with “joystick technique”, n=19) and group B (Ilizarov alone, n=34). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, side, preoperative fourth metatarsal length, preoperative shortening of the fourth metatarsal, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The operation time, intraoperative fluoroscopy frequency, total hospitalization costs, and complications were recorded and compared between groups. Metatarsal length was measured preoperatively and at 3 months postoperatively to calculate the lengthening amount. Foot function was evaluated using the AOFAS score preoperatively and at 4 months postoperatively. Patient satisfaction was assessed using a self-designed scale at 4 months postoperatively. Results All surgeries were successfully completed. The operation time and intraoperative fluoroscopy frequency were significantly lower in group A than in group B (P<0.05), while total hospitalization costs showed no significant difference (P>0.05). All patients were followed up, with a follow-up of (6.26±1.52) months in group A and (6.70±1.55) months in group B (t=?0.978, P=0.333). At 3 months postoperatively, the metatarsal lengthening was comparable between the two groups, with no significant difference (P>0.05). At 4 months postoperatively, AOFAS scores improved in both groups when compared with preoperative values, and the change in AOFAS score was greater in group A than in group B, the differences were significant (P<0.05). There were 2 cases of metatarsophalangeal joint stiffness and 1 case of metatarsophalangeal joint dislocation in group A, and 2 cases of nonunion, 2 cases of metatarsophalangeal joint dislocation, 3 cases of metatarsophalangeal joint dislocation with metatarsophalangeal joint stiffness, and 8 cases of simple metatarsophalangeal joint stiffness in group B. No pin-tract infection occurred in either group. The overall incidences of complications were 15.8% in group A and 44.1% in group B, with a significant difference (P<0.05). At 4 months postoperatively, patient satisfaction in group A was significantly better than that in group B (P<0.05). Conclusion The Ilizarov technique combined with the “joystick technique” can significantly optimize surgical efficiency, reduce intraoperative trauma and the risk of complications, and promote better functional recovery and patient satisfaction. It represents a favorable option for the treatment of fourth brachymetatarsia.

Citation： LIANG Jiachang, FENG Enhui, GUAN Hua, CHEN Pu, HE Jianbo, HUANG Weiming, XU Yiyin, XIE Jiewei. Clinical study of Ilizarov technique combined with “joystick technique” in treatment of fourth brachymetatarsia. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(8): 1241-1247. doi: 10.7507/1002-1892.202604016 Copy

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2.	Urano Y, Kobayashi A. Bone-lengthening for shortness of the fourth toe[J]. J Bone Joint Surg (Am), 1978, 60(1): 91-93.
3.	Shecaira AP, Fernandes RMP. Brachymetatarsia: One-stage versus two-stage procedures[J]. Foot Ankle Clin, 2019, 24(4): 677-687.
4.	Lamm BM. Percutaneous distraction osteogenesis for treatment of brachymetatarsia[J]. J Foot Ankle Surg, 2010, 49(2): 197-204.
5.	Barik S, Farr S. Brachymetacarpia and brachymetatarsia: do we need to operate?[J]. Efort Open Rev, 2021, 6(1): 15-23.
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7.	Fusini F, Alessandro M, Rava A, et al. Aetiology, diagnosis, and treatment of brachymetatarsia: A narrative review[J]. Musculoskelet Surg, 2022, 106(2): 99-109.
8.	Córdoba-fernández A, Vera-gómez ML. Literature review on brachymetatarsia[J]. Orthop Nurs, 2018, 37(5): 292-302.
9.	Smolle E, Scheipl S, Leithner A, et al. Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): A case series[J]. Foot & Ankle International, 2015, 36(3): 325-329.
10.	Lamm BM, Lamm TB. Brachymetatarsia: A classification for surgical treatment[J]. J Foot Ankle Surg, 2023, 62(1): 132-149.
11.	Lamm BM, Gourdine-shaw MC. Problems, obstacles, and complications of metatarsal lengthening for the treatment of brachymetatarsia[J]. Clin Podiatr Med Surg, 2010, 27(4): 561-582.
12.	Siddiqui NA, Mateen S, Thomas MA, et al. Comparing outcomes of acute versus gradual surgical correction in brachymetatarsia[J]. J Foot Ankle Surg, 2024, 63(2): 281-285.
13.	顧建明, 杜輝, 崔雅南, 等. 微創截骨單臂架骨延長術治療先天性跖骨短小癥[J]. 骨科, 2021, 12(3): 195-199.
14.	鄧偉, 劉熹, 陳宇, 等. 微創截骨結合Ilizarov技術治療先天性第4跖骨短小癥[J]. 中華骨與關節外科雜志, 2021, 14(6): 533-537.
15.	Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: surgical techniques, outcomes and complications[J]. Orthop Surg, 2024, 16(9): 2148-2156.
16.	梁家暢, 管華, 馮恩輝, 等. Ilizarov技術治療先天性第四跖骨短小癥: 延長比例亞組分析[J]. 中國組織工程研究, 2025, 29(33): 7217-7222.
17.	Lee KB, Park HW, Chung JY, et al. Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia[J]. J Bone Joint Surg (Am), 2010, 92(16): 2709-2718.
18.	Pe?a-martínez VM, Palacios-barajas D, Blanco-rivera JC, et al. Results of external fixation and metatarsophalangeal joint fixation with K-wire in brachymetatarsia[J]. Foot Ankle Int, 2018, 39(8): 942-948.
19.	蘇惠強, 王江波, 張勇, 等. 一期延長與漸進性延長治療先天性跖骨短小癥的療效比較[J]. 實用骨科雜志, 2023, 29(2): 116-120, 131.
20.	Zhu D, Lefèvre M, Fernandez A, et al. Brachymetatarsia: Surgical management, case report, and literature review[J/OL]. Case Rep Orthop, 2022, 2022: 8253096. doi: 10.1155/2022/8253096.
21.	Krakowski P, Rejniak A, Sobczyk J, et al. Cartilage integrity: A review of mechanical and frictional properties and repair approaches in osteoarthritis[J/OL]. Healthcare (Basel), 2024, 12(16): 1648. doi: 10.3390/healthcare12161648.
22.	Chen L, Zhang Z, Liu X. Role and mechanism of mechanical load in the homeostasis of the subchondral bone in knee osteoarthritis: A comprehensive review[J]. J Inflamm Res, 2024, 17: 9359-9378.
23.	Arceri A, Mazzotti A, Zielli SO, et al. What’s the evidence on surgical treatment for congenital brachymetatarsia: A systematic review and meta-analysis[J]. J Orthop, 2024, 49: 107-116.

1. Kim HT, Lee SH, Yoo CI, et al. The management of brachymetatarsia[J]. J Bone Joint Surg (Br), 2003, 85(5): 683-690.
2. Urano Y, Kobayashi A. Bone-lengthening for shortness of the fourth toe[J]. J Bone Joint Surg (Am), 1978, 60(1): 91-93.
3. Shecaira AP, Fernandes RMP. Brachymetatarsia: One-stage versus two-stage procedures[J]. Foot Ankle Clin, 2019, 24(4): 677-687.
4. Lamm BM. Percutaneous distraction osteogenesis for treatment of brachymetatarsia[J]. J Foot Ankle Surg, 2010, 49(2): 197-204.
5. Barik S, Farr S. Brachymetacarpia and brachymetatarsia: do we need to operate?[J]. Efort Open Rev, 2021, 6(1): 15-23.
6. Sepulveda M, Orellana G, Sanchez F, et al. Brachymetatarsia[J]. Efort Open Rev, 2024, 9(4): 235-240.
7. Fusini F, Alessandro M, Rava A, et al. Aetiology, diagnosis, and treatment of brachymetatarsia: A narrative review[J]. Musculoskelet Surg, 2022, 106(2): 99-109.
8. Córdoba-fernández A, Vera-gómez ML. Literature review on brachymetatarsia[J]. Orthop Nurs, 2018, 37(5): 292-302.
9. Smolle E, Scheipl S, Leithner A, et al. Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): A case series[J]. Foot & Ankle International, 2015, 36(3): 325-329.
10. Lamm BM, Lamm TB. Brachymetatarsia: A classification for surgical treatment[J]. J Foot Ankle Surg, 2023, 62(1): 132-149.
11. Lamm BM, Gourdine-shaw MC. Problems, obstacles, and complications of metatarsal lengthening for the treatment of brachymetatarsia[J]. Clin Podiatr Med Surg, 2010, 27(4): 561-582.
12. Siddiqui NA, Mateen S, Thomas MA, et al. Comparing outcomes of acute versus gradual surgical correction in brachymetatarsia[J]. J Foot Ankle Surg, 2024, 63(2): 281-285.
13. 顧建明, 杜輝, 崔雅南, 等. 微創截骨單臂架骨延長術治療先天性跖骨短小癥[J]. 骨科, 2021, 12(3): 195-199.
14. 鄧偉, 劉熹, 陳宇, 等. 微創截骨結合Ilizarov技術治療先天性第4跖骨短小癥[J]. 中華骨與關節外科雜志, 2021, 14(6): 533-537.
15. Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: surgical techniques, outcomes and complications[J]. Orthop Surg, 2024, 16(9): 2148-2156.
16. 梁家暢, 管華, 馮恩輝, 等. Ilizarov技術治療先天性第四跖骨短小癥: 延長比例亞組分析[J]. 中國組織工程研究, 2025, 29(33): 7217-7222.
17. Lee KB, Park HW, Chung JY, et al. Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia[J]. J Bone Joint Surg (Am), 2010, 92(16): 2709-2718.
18. Pe?a-martínez VM, Palacios-barajas D, Blanco-rivera JC, et al. Results of external fixation and metatarsophalangeal joint fixation with K-wire in brachymetatarsia[J]. Foot Ankle Int, 2018, 39(8): 942-948.
19. 蘇惠強, 王江波, 張勇, 等. 一期延長與漸進性延長治療先天性跖骨短小癥的療效比較[J]. 實用骨科雜志, 2023, 29(2): 116-120, 131.
20. Zhu D, Lefèvre M, Fernandez A, et al. Brachymetatarsia: Surgical management, case report, and literature review[J/OL]. Case Rep Orthop, 2022, 2022: 8253096. doi: 10.1155/2022/8253096.
21. Krakowski P, Rejniak A, Sobczyk J, et al. Cartilage integrity: A review of mechanical and frictional properties and repair approaches in osteoarthritis[J/OL]. Healthcare (Basel), 2024, 12(16): 1648. doi: 10.3390/healthcare12161648.
22. Chen L, Zhang Z, Liu X. Role and mechanism of mechanical load in the homeostasis of the subchondral bone in knee osteoarthritis: A comprehensive review[J]. J Inflamm Res, 2024, 17: 9359-9378.
23. Arceri A, Mazzotti A, Zielli SO, et al. What’s the evidence on surgical treatment for congenital brachymetatarsia: A systematic review and meta-analysis[J]. J Orthop, 2024, 49: 107-116.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study of Ilizarov technique combined with “joystick technique” in treatment of fourth brachymetatarsia

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