Case Report
 

By Dr. Fadwa Chami
Corresponding Author Dr. Fadwa Chami
Hopital Denfants de Rabat, - Morocco
Submitting Author Dr. Fadwa Chami
ORTHOPAEDICS

Bipartite,Patella,Adolescent,Pain,Duplication,After Trauma

Chami F. Bipartite Patella: Two Cases Reports. WebmedCentral ORTHOPAEDICS 2012;3(6):WMC003501
doi: 10.9754/journal.wmc.2012.003501

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 19 Jun 2012 05:32:49 PM GMT
Published on: 20 Jun 2012 09:07:11 PM GMT

Abstract


Kneecaps bipartite are defined as being a single kneecap the nucleus of secondary ossification of which did not merge with the rest of the kneecap. Some etiology are evoked. The patella bipartite is classically asymptomatic. The treatment is initially orthopaedic who can become surgical with satisfactory results. We bring report two cases of patella bipartita admitted in the service of surgery "B" of children's Hospital of Rabat-MORROCCO.

Introduction


Kneecaps bipartite are defined as being a single kneecap ,the nucleus of secondary ossification of which did not merge with the rest of the kneecap [ 1 ].

Two Cases Reports:


It is about  two boys, who were respectively 12 and 13 years old, sports, without particular pathological history and who consulted for an unilateral apyretic painful knee after traumatic. The clinical examination found a pain localized at the level of the par supéro-extern of the kneecap concerned with a knee joint which is free without patellar impact; and presence of the same tender spot at the level of the contralateral knee at a patient.   The standard roentgenogram had brought to light a nucleus of secondary ossification situated in the supéro-external pole of the kneecap at both patients with in the comparative knee:same image at a patient. [Fig 1, 2]. The treatment consisted of an important reduction of the weight bearing and the administration of anti - inflammatory non-steroidal at both patients and of a short antalgic plastered immobilization at a patient. The results are satisfactory with a drop of 1an.

Discussion


Bipartita patella was described for the first time by George [ 2 ] and Gruber [ 3 ] in 1883.
They are different from patellar duplications because in that case there is only a single kneecap the nucleus of secondary ossification of which did not merge with the rest of the kneecap. Some people, as Sheffield [ 4 ], consider however that the patellar duplications are a particular shape of patella bipartite. Classically, the nucleus of secondary ossification is situated in the pole supéroexterne of the kneecap, more rarely it is external or lower.
Saupe [5] classified in 1943 patellas bipartite in three groups according to the localization:
-Rank I: lower pole (5 % of the cases);
-Rank II: external edge (20 % of the cases);
-Rank III: pole supéroexterne (75 % of the cases).
Some etiology are evoked: pseudarthrosis, osteochondritis, anomaly of growth, this last one seeming the most likely. The nucleus of secondary ossification appears generally between 8 and 12 years [ 6 ] and in 2 % of the cases it do not merge with the rest of the kneecap. The patella bipartite is as well often unilateral as bilateral. The bipartita, classically asymptomatic patella, can however become painful [7-9], especially in children sportsman. The pains are often started by a trauma [7, 9]. These pains could be due to an equivalent of fracture of stress after repeated microtraumas [ 7,10 ]. The differential diagnosis often arises with the Disease of Sinding-Larsen-Johansson:osteochondritis of the point of the kneecap. [Fig 3] The treatment is initially orthopaedic [9] (decrease of the activities, the anti-inflammatory treatment per os or by local infiltration [7,8], fixed immobilization), but in case of defeat the recourse to the surgical treatment is necessary to realize an excision of this nucleus of secondary ossification. The results seem satisfactory with a disappearance of the pains.

Conclusion


The patella bipartite is a patellaire malformation of which it is necessary to think in front of a knee of painful traumatic comment at a sports teenager and which its treatment remains mostly orthopaedic.

References


1. E. Mayrargue, A. Hamel, S. Guillard, J.-M. Rogez. Anomalies congénitales de l’appareil extenseur du genou 15-230-A-10 2007 Elsevier Masson
2. George R. Bilateral bipartite patellae. Br J Surg 1935;22:555– 60.
3. Gruber W. In Bildungsanomalie mit Bildungshemmung begrundete Bipartition beider Patellae eines jungen Subjectes. Arch F Pathol Anat 1883;94:358–61.
4. Sheffield EG. Double-layered patella in multiple epiphyseal dysplasia: a valuable clue in the diagnosis. J Pediatr Orthop 1998;18:123-8.
5. Saupe H. Primare knochenmark Seilerung der Kniescheibe. Dtsche Z Chir; 1943 (228-386).
6. Ogden JA. Radiology of postnatal skeletal development. X. Patella and tibia tuberosity. Skeletal Radiol 1984;11:246-57
7. Bourne MH, Bianco AJ. Bipartite patella in the adolescent: results of surgical excision. J Pediatr Orthop 1990;10:69-73.
8. Marya KM,YadavV, Devagan A, Kundu ZS. Painful bilateral bipartite patellae: case report. Indian J Med Sci 2003;57:66-7.
9. Ogden JA, McCarthy SM, Joke P. The painful bipartite patella. J Pediatr Orthop 1982;2:263-9.
10. Zumstein M, Sukthankar A, Exner GU. Tripartite patella: late appearance of a third ossification center in childhood. J Pediatr Orthop B 2006;15:75-6.

Source(s) of Funding


None

Competing Interests


No competing interests

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