Posttraumatic Disturbance of the Epiphysis of the Humeral Trochlea: a spectrum of pathology.

Abstract Background Hegemann disease and fishtail deformity are classified as growth disturbances in the physeal plate of the humeral trochlea. It is questionable if these two diseases should be considered as two 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 two 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; two 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, prior to presentation. Decreased trochlear notch angle ( 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 one nomenclature for this pathologic process: posttraumatic disturbance of the epiphysis of the humeral trochlea (PDET).