Preossified longitudinal epiphyseal bracket of the foot: treatment by partial bracket excision before ossification.

The longitudinal epiphyseal bracket is a rare ossification defect of tubular bones in the hand and foot. This deformity contains an abnormal secondary ossification center, which may lead to progressive shortening and angular deformity of involved bones. This article describes the results from early treatment of this deformity before the secondary ossification center ossifies. Four patients with seven involved bones (5 metatarsals and 2 phalanges) were treated with surgical excision of the longitudinal epiphyseal brackets, without corrective osteotomy. The average age at surgery was 16 months (range, 6-20 months), and the average follow-up period was 55 months (range, 31-80 months). All five metatarsal patients demonstrated progressive improvement in the deformity. Of the two phalanx patients, one improved and the other did not. Early treatment of the longitudinal epiphyseal bracket before ossification of the secondary center with excision is effective in correcting this deformity. Long-term follow-up assessment until skeletal maturity is necessary to assess the final results of surgery because corrective osteotomy may be necessary for patients who do not have adequate correction.

Discography. a review.

BACKGROUND CONTEXT: Discography is used today as the basis of the diagnosis of discogenic back and neck pain. As such, it plays a pivotal role in the formulation of treatment plans for patients complaining of chronic axial spine pain. PURPOSE: A brief history of discography is described here, followed by a discussion of the current uses of discography, the technique involved, and recent studies questioning its validity. STUDY DESIGN/SETTING: A selective review of discography articles from peer-reviewed literature from 1967 to 2000 is provided. We included articles analyzing the validity of discography as well as those concerning its proper use, technique, and complications. METHODS: Articles relevant to the subject of discography were systematically reviewed for recommendations regarding technique, the interpretation of results, and conclusions regarding its validity. RESULTS: The specificity of discography is dramatically affected by the characteristics of the patient examined. In a patient with chronic pain states and psychiatric risk factors, the specificity was determined to be at most 20%. In healthy patients with no chronic pain states and a normal psychiatric profile, the specificity was found to be at most 90%. The ability of a patient to determine reliably the concordance of pain provoked during discography is poor. We could find no data addressing the sensitivity of the study. CONCLUSIONS: Clinicians who use discography to determine treatment pathways for their patients need to critically examine the validity of the test. Recent studies examining the specificity of discography have led us to proceed much more cautiously in interpreting the results of discography.