Spontaneous resolution of an osseous bridge affecting the distal tibial epiphysis.

The risk of developing an osseous bridge after certain types of epiphyseal injury is well established. Once formed subsequent growth will usually result in a progressive deformity. We present an unusual case in which such an osseous bridge formed and a deformity developed. The bridge then resolved spontaneously and the joint returned to normal alignment. Case report. A five-year-old girl injured her right ankle by trapping her foot beneath a bench which had then collapsed. Radiography showed a Salter-Harris type-III fracture of the distal tibial epiphysis with medial displacement (Fig. 1). The fracture was treated by closed manipulation and a plaster cast for seven weeks. After this was removed a full range of painfree movement was regained rapidly. At review 12 months later there was evidence of bony tethering across the epiphysis with some varus deformity at the ankle which increased to 18° at 15 months. At this stage tomography showed a localised osseous bar (Fig. 2). Two months later the child was admitted for operation on the bar, but radiographs showed that the amount of varus appeared to have decreased and surgery was deferred. After a further four months the shape of the ankle had clearly improved with talar tilt reduced from 18° to 10°. Two and a half years later the alignment of the ankle had been almost completely restored. She was last seen at the