A bipartite patella in a juvenile from a medieval context

Abstract

One hundred and thirty six well-preserved medieval skeletons were excavated in advance of re-development in Norwich. The right patella of a 13-15 year old skeleton (SK 65) displays a 'fracture line' running through the supero-lateral pole. This represents the fusion of a secondary ossification centre, a condition known as bipartite patella. It should not be confused with other anatomical variants or with pathological processes.

An anatomically based patient-specific finite element model of patella articulation: towards a diagnostic tool

“…d Anterior displacement of 8 mm to the tibial tubercle using a host-mesh and similarly e 8 mm medialisation. f A vastus lateralis release procedure for the treatment of a bipartite patella (source: Adachi et al 2002), and g a closeup of a right patella showing the fusion region (source: Anderson 2002). The refined mesh h before and i after a vastus release region of the lateral facet.…”

“…A bipartite patella is a rare condition occurring in less than 1% of the population whereby the patella is composed of two pieces (bipartite) and is rarely reported in the literature (Anderson 2002;Canizares and Slesnick 2003) The main patella is attached to a smaller fragment via fibrous tissue (Fig. 9g) and is distinguished from the more common patella fracture by a simple X-ray of the other knee joint, since the condition is bi-lateral (occurs in both knee-caps).…”

Several Infra‐cranial Non‐metric Variations in a Single Neolithic individual: A Common Genetic Underlying Predisposition?

“…However, others consider that it could be the result of an ossification defect because of abnormal stress produced by excessive action of the inserted musculature during development (Soren and Waugh, ). The ossicle may fuse to the main patellar body (see for instance Anderson, for an archeological case) or stays unfused. The reason for a presence or absence of fusion is still not understood (e.g.…”

“…The reason for a presence or absence of fusion is still not understood (e.g. Soren and Waugh, ; Anderson, ), but it is likely that genetic predisposition plays a role in some cases (Aloisio, ). It is also noteworthy that a case of bipartite patella has been described in association with an autosomal dominant disorder called nail–patella syndrome (Kumar et al ., ).…”

“…For all of these anatomical areas, authors indicate that fractures because of acute trauma can occur during adulthood, but: (i) they are very uncommon, and (ii) usually they can be easily distinguished from the non‐union form (e.g. Heikel, ; Merbs, ; Anderson, ; Case et al ., ). The changes seen in the individual studied here present the ‘classical’ aspect of a non‐union, and so do not seem related to acute trauma.…”