Person:

Claessen, Femke M. A. P.

Purpose To determine the most up-to-date theory on the aetiology of Panner’s disease, to form a consensus on the assessment of radiographs and to evaluate clinical outcome in order to summarise the best available evidence for diagnosis and treatment. Methods: A review of studies to date on Panner’s disease. Studies were eligible if: (1) the study provided criteria for defining Panner’s disease in order to eliminate confounding data on other radiographic entities that were mistakenly grouped and presented as Panner’s disease; (2) original data of at least one patient was presented; (3) manuscripts were written in English, German or Dutch; and (4) a full-text article was available. Animal studies, reviews and expert opinions were not included. Because the majority of the studies were case reports, we did not use an overall scoring system to evaluate methodological quality. Results: Twenty-three articles reporting on Panner’s disease were included. Most cases of Panner’s disease were unilateral in distribution and occurred in boys during the first decade of life. In general, conservative treatment is advised for Panner’s disease. Panner’s disease is a self-limiting disease and the majority of patients heal without clinical impairment. Conclusions: Based on the results of this review, Panner’s disease should be treated conservatively. Uniform names and descriptions of signs on radiographs would help to make the correct diagnosis. Since Panner’s disease is very rare, higher quality studies are not likely to be performed and, thus, this review provides the best level of evidence on the current knowledge about Panner’s disease.

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.