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. 2024 Feb 5;5(4):773.
doi: 10.55275/JPOSNA-2023-773. eCollection 2023 Nov.

Physiolysis for Metatarsal Bracketed Epiphysis

Barbara Minkowitz  1 , Colleen M Spingarn  1 , Aidan J Bertsch  1 , Julia M Fekete  1 , Jason A Rienzo  1 , Ellen Dean Davis  1 , Neil Shah  1 , Scott J Mubarak  2
Affiliations

Physiolysis for Metatarsal Bracketed Epiphysis

Barbara Minkowitz et al. J Pediatr Soc North Am. .

Abstract

Metatarsal bracketed epiphysis is an uncommon deformity with abnormally located/continuous physeal tissue along the diaphysis leading to shortening and angular deformity of the medially convex bone. Treatment of this condition is primarily surgical and varies depending on the stage. Treatment with early physiolysis to remove the excess growth plate is a surgical technique that has been previously reported. This method gives the greatest potential for correction of longitudinal and angular deformity of the bone as the patient grows. To our knowledge, there are no visual demonstrations of surgical techniques. For ease of visual demonstration of this procedure, we document its use in an 8-year-old female with Stage 3 bracketed epiphysis. Demonstration includes central physiolysis, using polymethylmethacrylate (PMMA) to block the regrowth of the bar. Key Concepts•Treatment of stage 3 bracketed epiphysis by central physiolysis and use of PMMA to block regrowth of the bar gives the affected bone the greatest potential for angular and longitudinal correction.•Outline the area to be excised using guide wires at each end of the bone and remove the bar (cartilage and epiphysis) found in between them, down to the trabecular bone in the diaphyseal area.•Use a centrally located threaded pin to anchor bone cement (PMMA), if needed.

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Figures

Figure 1
Figure 1
Abnormal physeal tissue bracketing medially along the diaphysis (Choo et al.). aFigure 1 from Longitudinal epiphyseal bracket by Choo AD, Mubarak SJ in Journal of Children’s Orthopaedics. 2013;7(6):449-454. doi:10.1007/s11832-013-0544-1.
Figure 2
Figure 2
Foot deformity indicated bracketed epiphysis (Choo et al. image at right). bFigure 1 from Longitudinal epiphyseal bracket by Choo AD, Mubarak SJ in Journal of Children’s Orthopaedics. 2013;7(6):449-454. doi:10.1007/s11832-013-0544-1.
Figure 3
Figure 3
Stages of bracketed epiphysis throughout growth (Choo et al). cFigure 3 from Longitudinal epiphyseal bracket by Choo AD, Mubarak SJ in Journal of Children’s Orthopaedics. 2013;7(6):449-454. doi:10.1007/s11832-013-0544-1.
Figure 4
Figure 4
Three-dimensional reconstruction of a foot CT (Choo et al.). dFigure 2 from Longitudinal epiphyseal bracket by Choo AD, Mubarak SJ in Journal of Children’s Orthopaedics. 2013;7(6):449-454. doi:10.1007/s11832-013-0544-1.
Figure 5
Figure 5
Diagram of 1st metatarsal ossified bracket treatment with PMMA (Choo et al). eFigure 6c from Longitudinal epiphyseal bracket by Choo AD, Mubarak SJ in Journal of Children’s Orthopaedics. 2013;7(6):449-454. doi:10.1007/s11832-013-0544-1.
Figure 6
Figure 6
Preop x-rays showing deformity of the great toe caused by bracketed epiphysis.
Figure 7
Figure 7
Preop CT confirming bracketed epiphysis (arrow).
Figure 8
Figure 8
Soft tissue was dissected down to the bone.
Figure 9
Figure 9
Locating the epiphyseal bracket.
Figure 10
Figure 10
Smooth guide wires placed parallel to growth plate.
Figure 11
Figure 11
Oscillating saw makes a groove near pins on either side of the wires.
Figure 12
Figure 12
Epiphysis and physis removed until trabecular bone was encountered.
Figure 13
Figure 13
Threaded guide wire placed centrally.
Figure 14
Figure 14
Area filled with PMMA.
Figure 15
Figure 15
Preoperative clinical photo (left) and at 1 year follow up (right).
Figure 16
Figure 16
X-ray images postop 1 year.
Figure 17
Figure 17
Central physiolysis in a 4-month-old child with 11-year follow-up.
See this image and copyright information in PMC

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References

    1. Choo A.D., Mubarak S.J. Longitudinal epiphyseal bracket. J Child Orthop. 2013;7(6):449–454. - PMC - PubMed
    1. Mubarak S.J., O'Brien T.J., Davids J.R. Metatarsal epiphyseal bracket: treatment by central physiolysis. J Pediatr Orthop. 1993;13(1):5–8. - PubMed
    1. Shea K.G., Mubarak S.J., Alamin T. Preossified longitudinal epiphyseal bracket of the foot: treatment by partial bracket excision before ossification. J Pediatr Orthop. 2001;21(3):360–365. - PubMed
    1. Weber M. New classification and score for tibial hemimelia. J Child Orthop. 2008;2(3):169–175. - PMC - PubMed
    1. Tibial Hemimelia. POSNA. Available at: https://posna.org/Physician-Education/Study-Guide/Tibial-Hemimelia#:~:te.... Accessed June 27, 2022.

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