Cleft epiphysis

Cleft epiphysis is a normal variant of an epiphysis. It can be either unilateral or bilateral. The most common site is the epiphysis of the first proximal phalanx of the foot.

Radiographic features

Plain radiograph

Plain radiographs will demonstrate a lucent defect in the epiphysis. The borders of the lucency are variable and may be sharp or irregular. The cleft remains until the fusion of the growth plate.

Differential diagnosis

A cleft epiphysis has to be differentiated from a fracture. Generally fractures demonstrate signs of healing if the radiograph is repeated 2-3 weeks after injury. Recognition of this entity is important to avoid over treatment and unnecessary surgical intervention.