Hi, this is Dr. Ali Reza Qasrobadi and I'm giving a talk on this novel technique for acute lengthening of the metatarsal for the treatment of brachial metatarsal. These are my credentials. I'm sorry, I'm going to be talking too fast because they only give me five minutes and I usually do this, it's an hour talk usually. So here are my experience for the past 15 years, usually using a uniplanar external fixation. I've done 630 cases using bone graft, would be 98 cases that I've done, and then using this new technique, 24 cases. As far as the last 24 months, I have created my own technique, which is called this GENIUS procedure. It stands for grafting, extensor tendon lengthening, neutralizing the impedium and internal fixation utilization of the spacer. This is what brachial metatarsia is, demographics. So patients, they usually have discomfort with the toe, pretty much sublux on the top and also have pain on the plantar aspect of the toe. Here's the multiple deformity example, congenital versus traumatic, which they can both occur when their growth plates are closing early. What's the goal of surgery? The goal of surgery is to obtain appropriate length and maintain function of the MP joint. Also maintain alignment of the metatarsal in all planes. Here's an example of the x-ray and the way it presents subluxation of the joint, multiple deformities as you can see. And then our surgical options, usually acute lengthening, gradual lengthening or combination of both. So on the left-hand side, you can see gradual lengthening, on the right-hand side, acute lengthening. As far as my preference so far for the past three years, gradual lengthening has been for the most part, 60% of them, and then 40% is my new technique. Pre-operative planning, we published this in the Baltimore when I was in fellowship over there. It predicts the length of the metatarsal. One of the most important or one of the most debilitating complication is the subluxation of the joint when you do acute lengthening or gradual lengthening. And it's always been difficult. These are the issues that I've had with acute lengthening, technically difficult to stretch the bone that much in one stage. And also because of the soft tissue restrictions, not having the appropriate instruments and laminar spatter is not good and also jamming of the joint at the end of it. And here is a patient that was sent to me, basically not successful lengthening. What I use is bone graft, tricortical, plates and screws, and fluoroscopy, and mini-rail external fixation to distract. I don't use epinephrine and I don't use tourniquet. Here's a case, I'm going to take you through it. Long incision at the level of the fourth metatarsal. You identify the extensor tendon, longus, and the brevis. If you want to do the lengthening, you do your lengthening now, but do not reattach at this point. Basically pull the tendons to the side. Here is a transfer. If you want to do a transfer to the adjacent tendon, you have to release all the soft tissues at the base of the proximal phalanx capsule, lumbricals, and also the interosseous. Complete release, except the plantar. The flexor tendon stays intact, but everything else gets released. The way you know that the release is complete is when you put your finger in there and you push it all the way out, you should be able to correct the deformity. That's how you know that you released the joint. Here's the trick. For the joint spacer, I put this fiber tape, make it into a donut by weaving it. Here's an example. And then make it into a complete donut by weaving it in and out. I'm just going to fast forward it. And then once it's done, it'll become pretty much like a donut-shaped spacer. And then once you do that, you insert a K-wire into the fourth digit. And then once it comes out of the joint, you can feed, you can put the spacer right over it and then advance the K-wire into the metatarsal head and neck. Here it is. That's what we're doing. And then you put the external fixation in this manner, basically from the side, completely from the side. And make sure that these pins are in the wound. And then these are out of the wound. And then one pin in the toe. And then you start extending. Make sure your alignment is perfect. This is when I was using a laminar spreader. As you can see, the wire is bent and it's not really that good. Here's what I created, the external fixation, a gap. And then I cut my tricortical bone and I insert it in there. As you can see, nice insertion right there. And then you have room to put the plates, at least the proximal pins, and maybe one screw distally. And then there you go. And then you can take the external fixation off and advance the K-wire all the way in. And then you close the skin. Removal of the spacer and also the K-wire would be at six weeks. I go to the side of the joint and I grab the spacer and I pull it out once the K-wire is removed. And then here's my, basically, here is my results before, during, before the K-wire removal, after the K-wire removal, and now. So this is a good example. Another example right here, and this is complete bone healing down here, up here is before we took the K-wire out. And here's another example, all views. I put my patients in a non-weight bearing compression and sometimes either a cam walker or you can cast them and weight bearing at four weeks. Spacer will be removed. Here's a patient that I did right and left foot, left foot without the spacer, right foot with the spacer. As you can see, it's a big difference. And that's about it. Thank you so much. If you have any questions, please call me or text me. I'll be available to answer any of your questions.

brachial metatarsal treatment

acute lengthening technique

GENIUS procedure

brachial metatarsia symptoms

surgical approach