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Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The normal variant of a bipartite patella is frequently misdiagnosed as a fracture. Fractures should be tender to the touch and associated with evidence of some soft tissue swelling. Some avulsion type fractures are associated with sporting injury or seen in patients with neuromuscular disability. A high riding patella with a lack of knee extension power may represent a ‘sleeve fracture’ where the patella tendon has pulled over the distal pole of the patella with a large piece of articular cartilage, which may be poorly visualised on the x-ray.
The lower limb
Published in Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson, Emergency Care of Minor Trauma in Children, 2017
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson
There are four types of image you may see. First is a true fracture of the body of the patella (Figure 9.8); second is a congenital bipartite patella, which may be mistaken for a fracture; third is the patellar sleeve fracture (Figure 9.9), which is the most difficult to spot; and lastly, a patellar dislocation can cause a small fracture (see ‘Patellar dislocation’). A congenital bipartite patella occurs when there is an accessory bone found in the upper, outer quadrant of the patella. The edges are rounded, and there are no matching clinical signs.
Injuries of the knee and leg
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
A fracture line running obliquely across the superolateral corner of the patella should not be confused with the smooth, regular line of a (normal) bipartite patella. Check the opposite knee; bipartite patella is often bilateral.
Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour
Published in Modern Rheumatology Case Reports, 2021
Fidelis Marie Corpus-Zuñiga, Keiichi Muramatsu, Ma. Felma Rayel, Yasuhiro Tani, Tetsuya Seto
The patella is one of those reported in literature as an atypical site for tophaceous gout. Several case reports were already written since 1955 (Table 1) [2–8]. Monosodium urate crystals become less soluble with lower temperatures, which could explain why gouty tophi often form in the distal end of an extremity such as the metatarsophalangeal joint of the first toes. The typical presentation of patellar gouty tophi usually involves the superolateral aspect of the patella, with noted involvement of the surrounding tendinous structures. The superficial nature and therefore lower temperature at the area of the patella could explain the formation of gouty tophi. The blood supply of the patella comes from a plexus of blood vessels [9]. The primary intraosseous blood supply of the patella has been described to flow in a retrograde fashion from distal to proximal, which is responsible for osteonecrosis of the superior fragment of the patella in cases of severely comminuted fractures [9]. In a bipartite patella, there is an avascular tissue interposed between the accessory bone and the main patellar bone fragment. This avascular tissue is composed mostly of fibrocartilage and less of fibrous and hyaline cartilage [10]. This alteration in the normal anatomy and blood flow in the patella could be one possible explanation as to why intra-osseous tophi of bipartite patellae often develops at the superolateral aspect of the patella.