RESUMEN
BACKGROUND: Hegemann disease and fishtail deformity are classified as growth disturbances in the physeal plate of the humeral trochlea. It is questionable if these 2 diseases should be considered as 2 distinct conditions. The aims of this study are to (1) point out similarities between both conditions, (2) discuss etiology, and (3) provide diagnostic tools. METHODS: In a multicenter prospective cohort study, 19 patients with growth disturbance of the humeral trochlea were included. Assessment consisted of a detailed history, physical examination, and standard radiographs in 2 directions. The radiographs were evaluated for skeletal age, carrying angles, and trochlear notch angles. Statistical analysis was performed using Stata. RESULTS: A total of 19 patients were included: 2 males (11%) and 17 females (89%). The mean age of the patients was 12.8 years. In 17 patients (89%), a traumatic injury of the elbow was reported, before presentation. Decreased trochlear notch angle (<104°) was seen in 16 patients (84%). Accelerated closure of the growth plate of the affected elbow was seen in all skeletally immature patients. CONCLUSIONS: The main risk factor for both Hegemann disease and fishtail deformity is an injury of the elbow with open growth plates. Imaging studies support the hypothesis that both diseases are likely to be a continuum of the same process. Therefore, we propose to use 1 nomenclature for this pathologic process: post-traumatic disturbance of the epiphysis of the humeral trochlea.
RESUMEN
BACKGROUND: It is unclear which tendon harvest for ulnar or lateral collateral ligament reconstruction has the lowest graft site morbidity rate. PURPOSES: To obtain graft site morbidity rates after tendon harvest for ulnar and lateral collateral ligament reconstruction procedures. STUDY DESIGN: Systematic review/Meta-analysis. METHODS: Studies were eligible if (1) patients had undergone elbow ligament reconstruction procedures; (2) original data for at least 5 patients were available; (3) the article was written in English, German, or Dutch; (4) a full-text article was available; and (5) information about graft site morbidity was available. The review excluded studies about complicated elbow ligament reconstruction procedures due to initial fractures, revision procedures, or circumferential graft techniques; animal studies; (systematic) reviews; and expert opinions. Because the majority of studies were case reports, no selection form or overall scoring system to evaluate methodological quality was used. RESULTS: The review included 619 patients with an ulnar or lateral collateral ligament reconstruction procedure. The autograft types used included palmaris longus tendon (58%), gracilis tendon (24%), semitendinosus tendon (8%), triceps tendon (7%), toe extensor tendon (<2%), plantaris tendon (<2%), extensor carpi radialis longus tendon (<1%), and Achilles tendon (<1%). CONCLUSION: Graft site morbidity occurred in 1% of the patients after an ulnar or lateral collateral ligament reconstruction procedure. This study did not have enough samples of all the autograft types to conclude that autograft type and graft site morbidity are unrelated.