in de orthopedische chirurgie

M.P. Somford

Panner disease

The original

In his paper from 1929 Panner mentions discussing the cases that follow during a meeting in 1927. At that time he had collected two cases but at the time of the writing of his paper he could add another one. The reason for de the delay in publication of the cases was because he wanted to follow their development and course over time. Three cases are described in detail, 2 boys of 10 years old and one boy of 7 years old. It all concerned asymptomatic elbows that became painful after trauma. No fractures were found on radiological examination but all three had an aberrant aspect of the capitulum [auth: not capitellum] humeri. It is interesting to see that even though Panner was a radiologist, he seemed to have examined the patients elbow to great extend and also performed the follow-up clinically and radiological. In his discussion he has the feeling the radiologic images have trauma as an incidental cause, but not as the essential one. The first stage is a flossy, uneven contour of the osseous centre of the capitulum humeri. In the subsequent course the osseous centre becomes smaller and gets deep indentations in the periphery. After shorter or longer time (longest seen is three years) the osseous centre becomes normal again. There is no connection between symptoms and greater or lesser deviation of the radiological findings from the normal. He classifies this condition as being in the epiphysis, comparable to Calvé-Perthes [auth: Legg was probably added later], except the absent deformation, which is often present in Calvé-Perthes disease. He states that dr. Krebs in 1927 published a case and names it ‘Maladie de Panner’, making the condition an eponymous term before the first publication in a paper. The proposed treatment consists of exercising a certain care when using the affected arm.1

The man

Hans Jessen Panner (13th of August 1871 - 11th of August 1930) was born in Rødby, Denmark.(figure 1) He was the son of a pharmacist. After studying medicine he started an internship in internal medicine in Germany and Austria. He decided however to pursue a career in radiology. In 1905 he became the head of the radiology department at the St Joseph Hospital in Copenhagen. He put a lot of effort in making radiology a separate specialty at the university in Denmark. His work and effort was troubled by him suffering from arthritis and later on diabetes, which also prevented him from becoming a professor of radiology. He was mainly interested in the radiology of the intestines and bone and joints. A particular interest was for the bone affections that arise around puberty. It is said that almost all radiologists in the 30’s in Denmark had been at some point his assistants. He was known for his kindly humour and warm genial spirit. He retired in 1928. He died in Helsingør and is buried in Frederiksberg.(figure 2)2

Figure 1: Hans Jessen Panner (orphan image).

Figure 2: Gravestone of Hans Jessen Panner and his wife at the Frederiksberg cemetery.

The clinical implication

Panner disease is an uncommon condition. It is mostly seen before the age of ten and 90% of the patients is male. Even today the aetiology is unclear. Preceding trauma is often seen but it remains uncertain whether this is the cause of Panner disease. Mostly the symptoms are pain and stiffness of the elbow, relieving with rest. Extension loss during physical examination is about 20 degrees and flexion loss is uncommon. The duration of symptoms ranges from several months to 2 years. The treatment is conservatively and most cases resolve without sequelae. Panner should not be confused with osteochondritis dissecans, which might have some similarities but needs different treatment.3

References 1. Panner HJ. A Peculiar Affection of the Capitulum Humeri, Resembling Calve-Perthes’ Disease of the Hip. Acta radiol. 1929. 2. Baastrup CI. Hans Jessen Panner in Memoriam. Acta radiol 1930; 11: 347–349. 3. Claessen FMAP, Louwerens JKG, Doornberg JN, et al. Panner’s disease: literature review and treatment recommendations. J Child Orthop 2015; 9: 9–17.