An Unusual Case of Bipartite Patella Fracture with Quadriceps Rupture

Abstract

Bipartite patella fracture with quadriceps rupture is an unusual injury. It is quite often mistaken as an avulsion fracture of patella, and the X-ray of contra-lateral knee is useful for diagnosis, and appropriate treatment should be decided at the time of surgery. We report a single case of this entity in which bipartite patella fracture was misdiagnosed initially as a patellar fracture. IntroductionThe secondary ossification centre of patella that fails to coalesce with the primary ossification centre results in bipartite patella. The incidence of bipartite patella in general population is about 2%, and about 50% are bilateral, and only 2% are symptomatic.Research suggests that 75% of patellae ossify by single centre and 23% ossify by two to three centres [1]. These secondary ossification centres usually appear around the age of 12 [1-3]. The primary centre of ossification generally appears between 21 and 54 months in girls and 36 and 72 months in boys [1].Saupe, in 1943, classified bipartite patella into the following three types: type I, located at the inferior pole, 5% of patients; type II, located at the lateral margin, 20% of patients; and type III is the superolateral location (most common type), 75% of patients [13].

Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture

“…These findings are not related to patellar fracture. Fourth, several features of the x‐ray films can help to differentiate bipartite patella from patella fractures: the bipartite patella is frequently bilateral; it is usually without soft tissue swelling of the knee joint; it usually consists of a large main bone and a small bone which is usually situated at the superolateral aspect of the patella; the radiolucent line of demarcation is wide, runs downward and lateral, and has a round sclerotic margin, not a fracture line; the opposing bony margins are smooth, dense, and can be seen to be composed of bone cortex; there is no periosteal reaction and bone callus formation; and consolidation will not occur by treatment. Reconstruction CT scans, magnetic resonance imaging, and bone scintigraphy can also help us to differentiate bipartite or multipartite patella from patella fracture, and MRI is currently thought to be the most appropriate method applied to evaluate patients with bipartite patella .…”

“…KEYWORDS: forensic science, forensic medicine, forensic identification, bipartite patella, misdiagnosed, patella fracture Bipartite patella is recognized as a developmental anomaly of ossification and is usually found by an incidental radiography (1,2). Gruber was the first to report a case of bipartite patella in 1883 (3), and he found that both patellae of a 21-year-old farmer were divided into a large lower inner fragment and a small upper outer fragment.…”

Bipartite patella separation with quadriceps tendon avulsion: A rare surgical case

“…The occurrence of bipartite patella simultaneously with quadriceps avulsion is an uncommon injury which is often misdiagnosed as a patellar avulsion fracture [1].…”

“…Bipartite patella occurs when the secondary ossification centre of the patella fails to fuse with the primary center [1]. It has an incidence of 2-6%, with males having a higher predisposition rate (8:1) [2].…”

Patella Bipartita

“…Patella embriyolojik olarak 8. haftada diz boşluğu ve kas taslağından önce, kuadriseps taslağının altında oluşur. Araştırmalara göre patella genelde (%75) tek bir ossifikasyon merkezinden gelişmektedir (2,3). Primer ossifikasyon merkezi kızlarda 21--54. aylar arasında erkelerde ise 36--72. aylar arasında ortaya çıkmaktadır (2).…”