Preossified longitudinal epiphyseal bracket of the foot: Treatment by partial bracket excision before ossification

The longitudinal epiphyseal bracket is a rare ossification defect of tubula r bones in the hand and foot. This deformity contains an abnormal secondary ossification center. which may lead to progressive shortening and angular deformity of involved bones, This article describes the results from early treatment of this deformity before the secondary ossification center ossifi es. Four patients with seven involved bones (5 metatarsals and phalanges) w ere treated with surgical excision of the longitudinal epiphyseal brackets? without corrective osteotomy. The average age at surgery was 16 months (ra nge, 6-20 months), and the average follow-up period was 55 months (range, 3 1-80 months). All five metatarsal patients demonstrated progressive improve ment in the deformity. Of the two phalanx patients. one improved and the ot her did not. Early treatment of the longitudinal epiphyseal bracket before ossification of the secondary center with excision is effective in correcti ng this deformity. Long-trim follow-up assessment until skeletal maturity i s necessary to assess the final results of surgery because corrective osteo tomy may be necessary for patients who do not have adequate correction.