Hypoplasia of bilateral humeral trochlea associated with bilateral ulnar nerve palsy

We document a case of bilateral ulnar nerve palsy that developed in an 27-year-old Japanese man who had bilateral hypoplasia of the humeral trochlea. Surgical management produced good results regarding the ulnar nerve palsy. The pathogenesis of the nerve paresis in this particular condition is discussed. There have been no reports outside Japan. Whether this deformity occurs only in persons of Japanese extraction or is simply overlooked by foreign surgeons is an interesting question. Received: 17 May 1999     

Aseptic osteonecrosis of the humeral trochlea (Hegemann's disease)

Summary A differential diagnosis of diseases affecting the elbow joint in children should also give due consideration to osteonecroses. They are very rare in the context of the humeral trochlea, the case with which we are concerned being one of a total of 15. In the light of this syndrome's relative rarity, we will report on the case of a 7-year-old boy. This is also the first time that a MR image of Hegemann's disease has been shown.

---

Zusammenfassung Bei der Differentialdiagnose von Erkrankungen des kindlichen Ellenbogengelenkes sind auch die aseptischen Knochennekrosen zu erwagen. An der Trochlea humeri sind sie sehr selten, mit dem von uns beschriebenen Fall sind es insgesamt 15. Wegen der relativen Seltenheit dieses Krankheitsbildes berichten wir kasuistisch über einen von uns beobachteten Fall bei einem 7-jährigen Jungen. Erstmals wird auch ein kernspintomographisches Bild eines Morbus Hegemann demonstriert.

---

---

Dedicated to Prof. D. Hohmann, Director of the Department of Orthopaedics, University of Erlangen-Nuremberg, on the occasion of his 60th birthday     

Bilateral cysts of the lateral femoral trochlea

We report the case of a young man with disabling anterior knee pain due to degenerative cysts of the subchondral bone confined to the lateral side of the femoral trochlea of both knees.     

Osteochondritis dissecans of the trochlea of the femur

This article defines the characteristic features of osteochondritis dissecans of the trochlea of the femur, and indicates that important differences distinguish it from the more familiar femoral condylar form. The clinical features in 16 knees included: gradual onset of symptoms, pain with running and jumping, no significant history of injury; inconstant tenderness of the trochlea, and pain with resisted extension at 20 to 45 degrees. Diagnosis was usually difficult, and was often delayed because of subtle radiographic changes. Treatment depended on the stage of presentation. Nonsurgical treatment failed in four of seven knees. Drilling the lesions failed in two of the three cases. Fixation with small screws produced two good results; two others healed, but with short follow-up. Removal of the loose bodies from six knees produced one poor result and five good results. This process differs in presentation from femoral condylar osteochondritis dissecans. Although the results (average follow-up more than 5 years) were generally good, the mild symptoms probably represent incongruity of the patellofemoral joint, and probably foretell osteoarthritis.     

Concomitant fractures of the capitellum and trochlea

A unique case of a coexistent fracture of the capitellum and trochlea is presented. The mechanism of injury and treatment options are reviewed.     

Fractures of capitellum and trochlea

The principles of management of capitellar and trochlear fractures are similar to any other intra-articular fracture. Accurate anatomic reduction, rigid internal fixation, and early mobilization of the elbow are prerequisites for a good functional result. Small fragments with minimal subchondral bone, not amenable to rigid internal fixation, are best treated by surgical resection. This article outlines the diagnosis, treatment, controversies, postoperative results, and complications of these rare elbow fractures.     

Neglected isolated fracture of the trochlea humeri

A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation, combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.     

Growth disturbance in aseptic osteonecrosis of the humeral trochlea (Hegemann's Disease): a case report with developmental distal radioulnar joint incongruency

A rare case of aseptic osteonecrosis of the humeral trochlea is described. The patient presented with a late onset of wrist pain caused by a length discrepancy with the short ulna relative to the radius. Close observation is needed for the regeneration of humeral trochlea, as well as for the significant effects of growth disturbance, which might cause the distal radioulnar joint incongruency.     

Hypoplasia of the abdominal aorta

A case of a 10 year old girl with hypoplasia of the inter-reno-mesenteric region of the abdominal aorta, which was accompanied by other pathological entities, is reported. The classification, etiology, clinical manifestations and diagnosis is discussed in detail. Successful treatment was accomplished with aorto-aortic bypass grafting and additional saphenous vein bypass from the aorta to the right renal artery. The conclusion of this study is that the hypoplasia of the abdominal aorta is a rare disease which may affect beyond the confines of the aorta and may involve the origins of vital arteries. Surgery offers the only chance of a favourable outcome.     

Nosology of osteochondrosis dissecans of the trochlea of the talus

The histories of 56 patients with the diagnosis "osteochondrosis dissecans tali" were retrospectively analyzed with regard to etiology, localization, therapy, course, and prognosis. Some of the patients were reexamined. In 33 patients it is highly probable that the osteochondrosis dissecans was not associated with the sequelae of osteochondral fractures. The typical X-ray image is that of a medial, deep osteolysis on the trochlea of the talus, close to the margin, with one or more roundish dissections. There are usually no degenerative or posttraumatic changes. The history and frequent bilateralism tend to rule out trauma as the cause. In the authors' opinion, therefore, the term "osteochondrosis dissecans" should not be used for osteochondral fractures and their sequelae. A number of borderline cases are critically discussed.