Treatment of first metatarsal longitudinal epiphyseal bracket by excision before closure

Abstract

The longitudinal metatarsal epiphyseal bracket is a rare ossification abnormality of tubular bones in which an abnormal epiphysis brackets the diaphysis of a phalanx, metacarpal, or metatarsal. This leads to progressive shortening and angular deformity of the involved bone. When it affects the first metatarsal, the longitudinal metatarsal epiphyseal bracket leads to a short, trapezoidal metatarsal. We present the case of a 6-year-old patient with an ossified longitudinal epiphyseal bracket along the medial side of the first metatarsal. The abnormality was surgically treated by bracket excision before physeal closure. At 6 years' follow-up, the patient displayed a normally aligned hallux of appropriate size in proportion to the other toes. Surgical correction resulted in alteration of the first metatarsophalangeal angle, which went from a preoperative value of 13 degrees of hallux varus to a postoperative value of 9 degrees of hallux valgus; the first metatarsal intraosseous angulation went from a preoperative value of 30 degrees to a postoperative value of 5 degrees , and the metadiaphyseal length index went from a preoperative value of 0.39 to a postoperative value of 0.92. This case study demonstrates that early resection of an ossified abnormal bracket before physeal closure, a relatively simple procedure, can restore longitudinal growth and correct angular deformity.