A recent presentation by Weaver' has called attention to the entity of the symptomatic bipartite patella. In that paper, the symptom complex and treatment were discussed. The points of differentiation of an acute fracture from a symptomatic bipartite patella were also briefly presented. We presented the following case, to underscore the fact that an acute fracture of the superolateral patella can clinically and radiographically simulate a symptomatic bipartite patella (Class III 2 ). CASE REPORTA 17-year-old high school soccer player was seen on October 30, 1978, 3 days after he was struck on the lateral aspect of his left knee by an opponent. He experienced acute pain over the proximal patella followed by several days of progressive swelling. He was able to weight-bear but was not able to run or kick. X-ray films taken at the time (Fig. 2) showed a slightly displaced fragment of the superolateral left patella and a moderate effusion, while films of the right knee were normal.On August 8, 1978, the patient had been seen for probable left patellar tendinitis. X-ray films of his left knee were obtained and showed a normal patella (Fig. 1 ). We were, therefore, able to conclude with certainty that the lesion seen radiographically on October 30, 1978 (Fig. 2) did, indeed, represent an acute fracture and not a bipartite patella.The patient was immobilized for 4 weeks in a cylinder cast. Repeat x-ray films on December 1, 1978 (Fig. 3) showed healing of the fracture. DISCUSSIONThe above case documents what many clinicians have suspected but have rarely been able to prove; i.e., that an acute fracture of the superior pole of the patella can simulate a bipartite patella. Fractures such as the one sustained by our patient, which are only slightly displaced, do not usually create total disruption of the quadriceps mechanism and can be entirely extraarticular. Therefore, two signs often thought diagnostic of patellar fractures (extensor lag and fat droplets in the aspirated hemarthrosis) may be absent. Furthermore, since such fractures may not cause total disability, patients may delay several days before seeking treatment thus further complicating the diagnostic problem.The ability to differentiate between a symptomatic bipartite patella and an acute fracture, of course, has therapeutic implications. Such a minimally displaced fracture would be expected to heal uneventfully if immobilized in a cylinder cast. However, if the fracture was mistaken for a bipartite patella and isometric exercises initiated, it is possible that a fibrous union would result.Weaver's paper' has rightfully created an increased awareness of the previously underpublicized entity of the symptomatic bipartite patella. We present this case to point out, however, that in cases of acute symptomatology (as in 6 of 21 1 in Weaver's series') the possibility of an acute fracture must be considered. When in doubt, we suggest that such cases be initially treated as fractures, especially when the uninjured patella is normal.A case of an acute fracture of the sup...
Freiberg's infraction is an avascular necrosis of the metatarsal head characterized by the development of disorderliness of chondrogenesis and osteogenesis in previously normal bone. Radiographic findings follow the pathological progression of bony changes. The presented cases document the development of avascular necrosis in a previously normal metatarsal that occurred after trauma or surgery elsewhere in the foot, it is suggested that infraction of the metatarsal head resulted from microfracture caused by abnormal stress.
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Tardily treated suppurative arthritis in infants and children results in permanent disability. Early diagnosis determines ultimate prognosis. In doubtful cases, the diagnosis should be established by aspiration or exploratory arthrotomy if necessary. This is particularly important in the newborn infant. Diagnostic aspiration should precede the administration of any antibiotic. Incision and drainage is the preferable method of evacuating an acutely infected joint. Symptoms of residual incongruity of a joint lag far behind the roentgenographic signs and do not ordinarily appear until the third decade of life.
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