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Pediatric longitudinal epiphyseal bracket: Review and case presentation.

Michael A Schreck¹

¹Foot and Ankle of West Georgia, 2751 Warm Springs Road, Suite A, Columbus, GA 31904, USA.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons

|September 5, 2006

Summary

A rare longitudinal epiphyseal bracket in the great toe, often missed by X-rays, can be diagnosed with ultrasound. Surgical removal can improve growth, but long-term monitoring is crucial.

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Area of Science:

Orthopedics
Pediatric Radiology
Developmental Biology

Background:

Longitudinal epiphyseal bracket (LEB) is a rare congenital anomaly affecting bone growth.
It occurs in 2-14% of congenital hand/foot deformities, with 11% in the great toe.
Early diagnosis is challenging as radiographs may appear normal before ossification.

Observation:

This case highlights a preossified LEB of the great toe.
Diagnosis was achieved through clinical suspicion and ultrasound, despite initially unremarkable X-rays.
Ultrasound effectively visualizes preossified LEB, confirming the diagnosis.

Findings:

Surgical resection of the epiphyseal brackets led to progressive short-term improvement.
The LEB deformity can cause significant growth aberrations in affected bones.
Early diagnosis and intervention are key to managing LEB.

Implications:

Ultrasound is a valuable tool for diagnosing preossified LEB when radiographs are inconclusive.
Prompt surgical intervention can yield positive outcomes in managing LEB.
Long-term skeletal monitoring is essential to ensure deformity resolution and guide further treatment if necessary.