PMC3808796_01
AP radiograph of the left foot showing 7 mm shortening of the 4th metatarsal compared to the 5th metatarsal head.
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Radiographs (Figure 1) showed a 4th metatarsal which was approximately 7 mm shorter that the 5th metatarsal with a dysplastic metatarsal head.
Diagram showing lengthening scarf osteotomy of the metatarsal (A) with bone grafts and Omnitech  screw fixation (B).
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Two 1cm allograft cancellous cubes (RTI Biologics, United States) were used and the osteotomy held with one Omnitech  screw (Biotech International, France) (Figure 2).
Post-operative AP radiograph at 6 weeks of the left foot showing the lengthening scarf osteotomy, incorporation of the bone blocks and fixation with an Omnitech screw  of the 4th metatarsal. The 4th metatarsal head is 2 mm longer than the 5th metatarsal head.
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The patient had routine post-operative follow up (Figure 3) and the additional length of 9 mm (2 mm longer than 5th metatarsal) had been maintained, however, there was some scar contracture keeping the toe dorsally elevated by ten degrees.