Background Eponymous terms are used frequently in daily patient care and scientific literature. They remind us of our predecessors in surgery. It is debatable whether eponymous terms are reliable in case of information transfer. The aim of our study was to investigate whether the original meaning of eponymous terms in shoulder and elbow surgery has been preserved in its use in contemporary literature.
Objective To evaluate whether eponymous terms were used correctly, we analysed the use of frequently encountered eponymous terms from January to December 2014.
Study selection By means of a PubMed search, articles with eponymous terms were identified and analysed for the way an eponymous term was used, and we compared it with the original description. The original description was traced back to the index publication. The use of the eponymous term was scored as similar, divergent or undefined. In the search for eponymous terms, we included those eponymous terms that were used more than 10 times in the English, German and Dutch literature of 2014. 6 eponymous terms were eligible for analysis: Bankart lesion, Bristow-Latarjet procedure, Essex-Lopresti injury of the forearm, Galeazzi fracture, Hill-Sachs lesion and Monteggia fracture.
Findings We analysed 96 articles with the listed eponymous terms, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar. Bristow-Latarjet scored lowest, with 0% descriptions similar to the original, meaning that all articles had an undefined or divergent eponym, and Essex-Lopresti scored highest with 82% similarity.
Conclusions Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided, but since the majority of eponymous terms are not used properly and understanding of its meaning and content varies from surgeon to surgeon, we should be keen on explaining the meaning of eponymous terms when using them.
Statistics from Altmetric.com
When the name of an inventor or discoverer is used to describe a condition, procedure or fracture it is called an eponymous term and the namegiver becomes an eponym. Eponymous terms recognise some of the pioneers in the field. In contrast with an anatomical or developmental description, the original meaning of an eponymous term may have been lost over time. New insights in pathology, pathoanatomy and trauma mechanisms can make the use of historical eponymous terms inappropriate. Adaptations of the original meaning might develop over time and may lead to improper use and understanding of eponymous term. With time, insights into and development of new techniques for diagnosis and operative care change. This can result in modification of eponymous terms.
New nomenclature may even become more appropriate than the historical eponymous term. We are all aware of the need to speak the same language in order to avoid misinterpretation and errors. It is under debate whether eponymous terms contribute to avoid confusion. Misspelling of an eponymous term may make publications on a subject untraceable. This is especially the case with foreign names or words that are used in the English-language literature and vice versa.
With our current research, we tried to establish whether eponymous terms are still used in current literature and whether their original meaning was used.
Materials and methods
To establish whether eponymous terms are correctly used in current literature, 12 common eponymous terms for traumatic conditions of shoulder and elbow were selected (table 1) on a consensus basis by a committee of experts in the field of upper extremity injuries. A PubMed search was conducted to find articles that used the eponymous terms. The search was limited to journal publication dates between 1 January 2014 and 1 January 2015. Possibly misspelled eponymous terms were included in the search, as were eponymous terms with 10 or more hits. This resulted in six eponymous terms that were eligible for our study. Languages were limited to English, German and Dutch. Systematic literature reviews were excluded. Current concept articles were not excluded.
For the six selected eponymous terms, the original description was traced by means of historical research. The search was conducted by backtracking references up to the original description or analysis of textbooks written by the person whose eponymous term is discussed. After identifying the index publication, the sentence or passage on which the eponymous term is based was carefully identified and used to compare it with the current articles.
On identification, the articles were analysed for the description of the eponymous term itself and then compared with the description in the original publication. This was done by three authors. When the authors were not unanimous, consensus was met after discussion on the score given. If the description in current articles did not meet the original one, the article was scored as ‘divergent’; if there was no clear description of the eponymous term, it was scored as ‘undefined’. If the description was the same as the original manuscript, it was scored ‘similar’. In case that the authors chose to use a modification of the eponymous term but stated the original meaning in their material and methods, the article was scored as ‘similar’ too. No analysis was done to ascertain the quality of research or to interpret the outcomes of the articles. The six eponymous terms selected are (table 1 and figure 1) as follows:
Bankart (also Bankert) lesion, excluding ‘Bankart procedure’ and ‘bony Bankart’
Bristow-Latarjet (also Laterjet) procedure
Essex-Lopresti injury of the forearm
Galeazzi (also Galeazi) fracture
Hill-Sachs lesion, excluding reverse Hill-Sachs
Monteggia (also Montegia) fracture
From the original publications, these eponymous terms are defined as follows:
The Bankart lesion (Arthur Sidney Blundell Bankart, 1879–1951) is a detachment of the glenoid ligament from the anterior margin of the glenoid cavity after anterior glenohumeral injury.1 It should be noted that ‘bony Bankart’ is an interesting term, as Bankart wrote explicitly that he never had seen recurrent dislocation after glenoid fracture or bony abnormality.1 Therefore the ‘bony Bankart’ is excluded from our analysis.
The Bristow-Latarjet procedure (Walter Rowley Bristow, 1882–1947, and Michel Latarjet, 1919–1999) is a difficult eponymous term, since it comprises two surgical procedures that are very much alike but not the same. The distinctive similarity between the Bristow and Latarjet procedures is the use of the coracoid for anterior shoulder stabilisation. Bristow used only the tip of the coracoid and fixed the conjoined tendon to a slit in the subscapular muscle with sutures, as described by Helfet in 1958.2 Latarjet used the whole coracoid and fixed it with one screw, and raved the anterior shoulder capsule, as he described in 1958.3 Only stating ‘coracoid transposition’ is not specific enough to establish the exact technique used, so the articles using this description were scored as ‘undefined’.
The Essex-Lopresti injury (Peter Gordon Essex-Lopresti, 1915–1951) of the forearm was described in 1951 as a comminuted radial head fracture with dislocation of the distal radioulnar joint and disruption of the interosseous membrane.4
Galeazzi (Riccardo Galeazzi, 1891–1961) in his original articles from 1934 and 1935 described a fracture of the radius with dislocation of the distal radioulnar joint.5 ,6 This fracture came to bear his name.
Hill and Sachs (Harold Arthur Hill, 1901–1973, and Maurice David Sachs 1909–1987) described in 1940 a distinctive defect in the humeral head after anterior shoulder dislocation. It is a compression fracture that shows four specific characteristics radiologically: (1) It is at the posterolateral location of the humeral head; only very large defects extend into the greater tuberosity. (2) In external rotation the defect is subtle and often overlooked. (3) The indentation is best seen with the arm in internal rotation and presents as a dense line of ‘condensation’. (4) An avulsed fragment from the humerus is practically never present; there may be a small chip from the inferior portion of the glenoid rim.7 Since Hill and/or Sachs did not describe the reversed type of this lesion, articles on this subject were excluded.
Monteggia (Giovanni Battista Monteggia, 1762–1815) described in 1814 a fracture of the proximal third of the ulna combined with an anterior dislocation of the radial head at the proximal radioulnar joint.8 A fracture at any site of the ulna with any kind of proximal radial dislocation was described by Hamilton and Malgaigne, but the majority of these fractures are not by definition a Monteggia fracture.9
Initial search with the keywords ‘Bankart lesion’ and ‘Bankert lesion’ produced 40 hits in PubMed, and after exclusion of abstract and full text, 24 were included for final analysis (graph 1).10–33 The excluded articles were in a different language (two Spanish, one Czech), reported on Bankart repair (3) or bony Bankart lesions (6) or were systematic reviews (4). Nine (37%) articles did not clearly define a Bankart lesion. Four (17%) descriptions were divergent, and the remaining 11 (46%) had a description similar to the original one (table 2).
Initial search with the keywords ‘Bristow-Latarjet procedure’ and ‘Bristow-Laterjet procedure’ produced 11 hits in PubMed, and after exclusion of abstract and full text, 8 remained for final analysis (graph 1).28 ,34–40 The excluded articles were systematic reviews. Two (25%) articles did not clearly define a Bristow-Latarjet procedure. Six (75%) descriptions were divergent and none had a description similar to the original one (table 3).
Essex-Lopresti injury of the forearm
Initial search with the keywords ‘Essex-Lopresti injury of the forearm’ produced 12 hits in PubMed, and after exclusion of abstract and full text, 11 remained for final analysis (graph 1).41–51 The excluded article was a letter to the editor. One (9%) article did not clearly define an Essex-Lopresti injury. One (9%) description was divergent, and the remaining nine (82%) had a description similar to the original one (table 4).
Initial search with the keywords ‘Galeazzi fracture’ and ‘Galeazi fracture’ produced 11 hits in PubMed, and after exclusion of abstract and full text, 10 remained for final analysis (graph 1).52–61 The excluded article was in a different language (French). Four (40%) articles did not clearly define a Galeazzi fracture. One (10%) description was divergent, and the remaining five (50%) had a description similar to the original one (table 5).
Initial search with the keywords ‘Hill-Sachs lesion’ produced 31 hits in PubMed, and after exclusion on abstract and full text, 22 remained for final analysis (graph 1).15 ,17 ,24–29 ,31 ,32 ,62–73 The excluded articles were in a different language (two Spanish, one Czech), reported on reverse Hill-Sachs lesions (3), or were systematic reviews (3). In total, 7 (32%) articles did not clearly define a Hill-Sachs lesion. A total of 5 (23%) descriptions were divergent, and the remaining 10 (45%) had a description similar to the original one (table 6).
Initial search with the keywords ‘Monteggia fracture’ and ‘Montegia fracture’ produced 23 hits in PubMed, and after exclusion of abstract and full text, 21 remained for final analysis (graph 1).53 ,74–93 The excluded articles were in a different language (two Chinese). In total, 11 (52%) articles did not clearly define a Monteggia fracture. A total of 5 (24%) descriptions were divergent, and the remaining 5 (24%) had a description similar to the original one (table 7).
In total, 96 articles were analysed, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar.
Although our series are small, it is the first time that the use of eponymous terms is studied in this manner. We limited our search to the year 2014 since our goal is to get a contemporary idea of the use of eponyms and we did not have the intention to do a thorough historical analysis of past use of the chosen eponymous terms. The major finding of our analysis is that the majority of eponymous terms are not used as originally described (61%). There was a large variety in the results, but a 100% match between the original description of the eponymous term and the meaning of the same eponymous term in our study period was not found. For the Bristow-Latarjet procedure none of the recently used eponyms were in concordance with the original. The reason that 75% of the recent descriptions diverged from the original one is because of the complex nature of this eponymous term, which encompasses two techniques. By stating this in the Materials and Methods section and by referring to the used technique, it is possible to still use the eponymous. A similar description can thus be named, although using only one or maybe a variation of the technique.
The use of eponymous terms in orthopaedic surgery is a well-known mirror of our professional past. Eponymous terms commemorate the pioneers that shaped our profession the way it is practiced today, although it is possible that the eponym is not the one that first described the condition that came to bear his name. This is known as Nonoriginal Malappropriate Eponymous Nomenclature (NOMEN).94 However, in the years following the initial description of certain conditions or surgical techniques, advancing insights changed classifications of diagnoses/pathologies and treatment algorithms. The original description might therefore no longer be appropriate. Often an addition of a ‘variant’ or ‘modification’ to the eponymous term is used to show that its meaning has been changed. This is in concordance with Ravitch's statement on eponyms that: ‘1) The man so honoured was not the first to describe the disease, operation or instrument; 2) He misunderstood the situation; 3) He is generally misquoted; and 4) 1, 2 and 3 are simultaneously true’.95 This can add complexity to the scientific comparison and discussion. It is important to determine whether the definition is similar when talking, reading or writing about a condition or surgical technique. It has been shown that it might not be the case when using eponymous terms.96
The origin of eponymous terms is diverse; it varies from citing the first or most well-known author of the original description in an article97 or book98 to using it to honour the person we learnt from.2 Sometimes the original author himself dedicates the finding to his own name.99 Independently of origin, eponymous terms are and will remain part of our daily routine.
Eponymous term divergence may be due to a lack of specificity in the description given in the current literature. It would take a larger group with focus on one single eponymous term to investigate this. When a new description appeared for the analysed eponymous terms, our results did not show it as being used by all the authors. Divergent descriptions can be ascribed to a variety of reasons (all tables).
The group that kept the eponymous term undefined poses difficulties. This would only be a theoretical problem if all the other descriptions were similar to the original ones, and (although scientifically it is not appropriate) we could assume that the undefined eponymous term is used similarly to the original description. As this is not the case, we cannot be sure that the articles that did not define the meaning of the eponymous term used it correctly. This makes the research results hard to interpret and apply in our daily practice.
Systematic reviews were excluded, because they report on other (older) articles and do not necessarily use the eponymous term as a distinctive marker themselves. Although excluded for this reason, the article by Trivedi et al100 is an interesting example of erroneous use of eponymous terms, since it states that a Bankart lesion is defined as glenoid bone loss. Their recommendations should be carefully interpreted, as a search for Bankart lesions for that review will mostly result in articles reporting on labral tears; hence, the definitive article selection should be corrected for this. It probably means that over time adaptation of the Bankart lesion has occurred. In the past, bony avulsion was referred to as a ‘bony Bankart’ and over time the condition was attributed to Bankart.
A limitation to our study is that we chose a time span of 1 year to search our articles in. We feel though that this results in enough articles we could analyse to answer our research question for this study. Since it was the first time this kind of study was performed, we chose to keep the limit to this time span as a form of pilot. Further studies could direct their search on a limited amount of eponymous terms from the first time they are described up until today to obtain a clear understanding of the use of the eponymous term over time.
Another limit is that the study is restricted to elbow and shoulder surgery; therefore, it might not be applicable to other specialties. The found literature on the debate, whether or not eponyms should be used, is from all kinds of specialties, so the issue seems applicable to general medicine. To research all fields of medicine in one study would be better but unrealistic in our view, since there are more than 20 000 medical eponyms.101 ,102
We recommend describing the lesion in relation to the local (patho)anatomy or trauma mechanism since it is less prone to misinterpretation. When an eponymous structure, lesion or therapy is used, the Materials and Methods section should specify the used anatomical/pathological meaning of the eponymous term. A reference to the original description or the description used should also be given. When the description diverges from the original, it should be stated in what way the eponymous term is being used.
Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided in scientific literature and in daily patient care, but it should be regarded with care.103 ,104 This, since the majority of eponymous terms are not used according to their original description and understanding of their meaning, differs among medics and researchers. Since eponymous terms are hard to abolish in our daily practice and an explanation on their meaning will not always be given, we propose that when used in the scientific literature, the original description or current use should be clarified. The Materials and Methods section of each article should explicitly specify the supposed meaning of the used eponymous term. Only then can we interpret the results correctly.
Contributors MPS contributed to study design, literature search, data collection, data analysis, data interpretation and manuscript writing. RANW contributed to study design, data collection, data interpretation, figures/tables preparation and correction of manuscript. CNvD contributed to writing and correction of manuscript. FFAI contributed to data interpretation, writing and correction of manuscript. DE contributed to study design, data interpretation, writing and correction of manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.