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Longitudinal Epiphyseal Bracket as an Overlooked Etiology of Congenital-Residual Hallux Varus: A Case Report

Barış Kadıoğlu
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Melih Güven
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Budak Akman
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Namık K. Özkan
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Longitudinal epiphyseal bracket is a rare ossification disorder of the short tubular bones. The affected bone becomes deformed as a result of the bracket. The normal growth pattern cannot occur, and when it affects the first metatarsal bone, hallux varus may develop with the abnormal growth pattern. We present such a 6-year-old patient who had undergone surgery at 6 months of age for hallux varus and polydactyly. The deformity had worsened gradually after the initial operation because of the overlooked longitudinal epiphyseal bracket. The patient was treated with surgical excision of the epiphyseal bracket, with corrective medial open wedge osteotomy and split transfer of the extensor hallucis longus tendon. The result was excellent at the 20-month follow-up. At an early age, patients who present with hallux varus must be checked for the epiphyseal bracket, which can be invisible on radiographs because of the chondral structure. Untreated or overlooked patients with epiphyseal bracket will need revision operations for recurrent deformities.

Ataşehir Florence Nightingale Hospital, İstanbul, Turkey.

Yeditepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey. Dr. Guven is now with Ataşehir Florence Nightingale Hospital.

Corresponding author: Baris Kadioglu, MD, Ataşehir Florence Nightingale Hospital, Küçükbakkalköy Mahallesi Işıklar Caddesi 35/A, İstanbul 34750, Turkey. (E-mail: baris1504@gmail.com)