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Hegemann's disease and fishtail deformity: aetiopathogenesis, radiographic appearance and clinical outcome.

Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, van den Bekerom MP, Eygendaal D - J Child Orthop (2015)

Bottom Line: Animal studies, reviews and expert opinions were not included.Additional imaging is advised to confirm the presence of a fishtail deformity, intra-articular loose bodies and signs of osteoarthritis to decide if, and what, operative treatment is needed.As long as no clear aetiology for both diseases exist and the clinical symptoms and radiographic appearance are difficult to distinguish, both entities should preferably be named as 'vascular disturbance of the trochlear growth plate' to overcome confusing definitions and discussions.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School and University of Amsterdam Medical School, Boston, MA, USA, femke__claessen@hotmail.com.

ABSTRACT

Purpose: A systematic review regarding clinical studies on Hegemann's disease and fishtail deformity was performed with the aims to: (1) formulate the most up-to-date theory on aetiology in order to better define these conditions, (2) summarise the most frequent radiographic descriptions on radiographs and (3) give an overview of different treatment options.

Methods: A systematic review of studies to date on Hegemann's disease and fishtail deformity was performed. Studies were eligible if: (1) the article provides a description of Hegemann's disease or fishtail deformity, (2) original data of at least one patient was available, (3) the article was written in English, German or Dutch and (4) a full manuscript was available. Animal studies, reviews and expert opinions were not included.

Results: We included a total of 22 articles: seven regarding Hegemann's disease including eight patients and 15 regarding fishtail deformity including 58 patients.

Conclusions: Fishtail deformity and Hegemann's disease seem to be a spectrum of vascular disorders of the distal humerus, varying from a benign mild vascular disorder to a complete avascular necrosis after fractures. Additional imaging is advised to confirm the presence of a fishtail deformity, intra-articular loose bodies and signs of osteoarthritis to decide if, and what, operative treatment is needed. As long as no clear aetiology for both diseases exist and the clinical symptoms and radiographic appearance are difficult to distinguish, both entities should preferably be named as 'vascular disturbance of the trochlear growth plate' to overcome confusing definitions and discussions.

No MeSH data available.


Related in: MedlinePlus

Stages of Hegemann’s disease
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Fig2: Stages of Hegemann’s disease

Mentions: In all reports, standard radiographs were used for diagnosing Hegemann’s disease and fishtail deformity. There is no gold standard for diagnosing Hegemann’s disease and fishtail deformity. However, signs of fishtail deformity are shown earlier on CT and MRI, although at the time Hegemann’s disease was first diagnosed neither CT nor MRI were available. Therefore, the fishtail deformity could be another (next) stage of Hegemann’s disease, which is benign after a mild vascular disorder. A complete avascular necrosis could develop after traumatic events. Alternatively Hegemann’s disease is a benign, self-limiting stage of fishtail deformity after unrecognised injury or (repetitive) micro-trauma. Hegemann’s disease is characterised by irregularity of the trochlea and sclerosis. Schumacher et al. [30] classified Hegemann’s disease into five different stages based on radiographs: stage 1: initial loss of density and later plaque-shaped sclerosis of the centre of epiphyseal ossification; stage 2: reduction in size and condensation of the ossification centre; stage 3: loosening, accompanied by onset of new ossification; stage 4: regeneration and enlargement of the ossification centre; and stage 5: final stage (complete or partial recovery) (Fig. 2). A central deficiency of the distal humeral epiphysis is characteristic for fishtail deformity [4]. Radiographs should always be compared to the asymptomatic elbow, as the appearance of the growth plate of the trochlea differs between individuals.Fig. 2


Hegemann's disease and fishtail deformity: aetiopathogenesis, radiographic appearance and clinical outcome.

Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, van den Bekerom MP, Eygendaal D - J Child Orthop (2015)

Stages of Hegemann’s disease
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340852&req=5

Fig2: Stages of Hegemann’s disease
Mentions: In all reports, standard radiographs were used for diagnosing Hegemann’s disease and fishtail deformity. There is no gold standard for diagnosing Hegemann’s disease and fishtail deformity. However, signs of fishtail deformity are shown earlier on CT and MRI, although at the time Hegemann’s disease was first diagnosed neither CT nor MRI were available. Therefore, the fishtail deformity could be another (next) stage of Hegemann’s disease, which is benign after a mild vascular disorder. A complete avascular necrosis could develop after traumatic events. Alternatively Hegemann’s disease is a benign, self-limiting stage of fishtail deformity after unrecognised injury or (repetitive) micro-trauma. Hegemann’s disease is characterised by irregularity of the trochlea and sclerosis. Schumacher et al. [30] classified Hegemann’s disease into five different stages based on radiographs: stage 1: initial loss of density and later plaque-shaped sclerosis of the centre of epiphyseal ossification; stage 2: reduction in size and condensation of the ossification centre; stage 3: loosening, accompanied by onset of new ossification; stage 4: regeneration and enlargement of the ossification centre; and stage 5: final stage (complete or partial recovery) (Fig. 2). A central deficiency of the distal humeral epiphysis is characteristic for fishtail deformity [4]. Radiographs should always be compared to the asymptomatic elbow, as the appearance of the growth plate of the trochlea differs between individuals.Fig. 2

Bottom Line: Animal studies, reviews and expert opinions were not included.Additional imaging is advised to confirm the presence of a fishtail deformity, intra-articular loose bodies and signs of osteoarthritis to decide if, and what, operative treatment is needed.As long as no clear aetiology for both diseases exist and the clinical symptoms and radiographic appearance are difficult to distinguish, both entities should preferably be named as 'vascular disturbance of the trochlear growth plate' to overcome confusing definitions and discussions.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School and University of Amsterdam Medical School, Boston, MA, USA, femke__claessen@hotmail.com.

ABSTRACT

Purpose: A systematic review regarding clinical studies on Hegemann's disease and fishtail deformity was performed with the aims to: (1) formulate the most up-to-date theory on aetiology in order to better define these conditions, (2) summarise the most frequent radiographic descriptions on radiographs and (3) give an overview of different treatment options.

Methods: A systematic review of studies to date on Hegemann's disease and fishtail deformity was performed. Studies were eligible if: (1) the article provides a description of Hegemann's disease or fishtail deformity, (2) original data of at least one patient was available, (3) the article was written in English, German or Dutch and (4) a full manuscript was available. Animal studies, reviews and expert opinions were not included.

Results: We included a total of 22 articles: seven regarding Hegemann's disease including eight patients and 15 regarding fishtail deformity including 58 patients.

Conclusions: Fishtail deformity and Hegemann's disease seem to be a spectrum of vascular disorders of the distal humerus, varying from a benign mild vascular disorder to a complete avascular necrosis after fractures. Additional imaging is advised to confirm the presence of a fishtail deformity, intra-articular loose bodies and signs of osteoarthritis to decide if, and what, operative treatment is needed. As long as no clear aetiology for both diseases exist and the clinical symptoms and radiographic appearance are difficult to distinguish, both entities should preferably be named as 'vascular disturbance of the trochlear growth plate' to overcome confusing definitions and discussions.

No MeSH data available.


Related in: MedlinePlus