Physiolysis for Metatarsal Bracketed Epiphysis.

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.