We analysed the clinical and radiological outcomes of a new surgical technique for the treatment of heterozygote post-axial metatarsal-type foot synpolydactyly with HOX-D13 genetic mutations with a mean follow-up of 30.9 months (24 to 42). A total of 57 feet in 36 patients (mean age 6.8 years (2 to 16)) were treated with this new technique, which transfers the distal part of the duplicated fourth metatarsal to the proximal part of the fifth metatarsal. Clinical and radiological assessments were undertaken pre- and post-operatively and any complications were recorded. Final outcomes were evaluated according to the methods described by Phelps and Grogan. Forefoot width was reduced and the lengths of the all reconstructed toes were maintained after surgery. Union was achieved for all the metatarsal osteotomies without any angular deformities. Outcomes at the final assessment were excellent in 51 feet (89%) and good in six (11%). This newly described surgical technique provides for painless, comfortable shoe-wearing after a single, easy-to-perform operation with good clinical, radiological and functional outcomes.

Cite this article: Bone Joint J 2013;95-B:929–34.

Introduction: One of the most frequently seen complications of structural allograft recontructions are either delayed or nonunion. The effect of the periosteum on union of autoclaved segmental bone grafts were investigated in rabbits.

Method: Segmental bone defects, 10 milimeters long, in the middle of the left radius were created in 16 adult rabbits. The resected bones, autoclaved 15 minutes at 120 C and reimplanted and fixed with intramedullary Kirchner wires. In group one, 8 rabbits’ graft-host bone junctions were covered with periosteal fiap and in group two, graft-host bone junctions were deperiostized. The plain X-rays were taken at 2, 4, 6 and 8 weeks. The rabbits were sacrificed at the end of 8 weeks. Specimens were also examined histologically.

Results: Both radiological and histological results were evaluated. In group one, the results revealed more callus and healing than group two, and they were found statistically significant.

Discussion: Periosteal fiaps are easy to perform and enhances the healing of the graft-host junctions. The periosteal fiap technique is effective on the healing of graft-host bone junctions and this technique will worth applying to structural allografts.