Patella cubiti - a continuing etiological mystery / Patella cubiti: un misterio etiológico continuo

SUMMARY: A sesamoid bone in the elbow joint is a rare anatomical variation described as a Patella cubiti. Although this variation has been known for centuries its exact etiology is still unclear. Congenital, developmental, and traumatic hypotheses have been proposed. It seldom causes clinical manifestations than elbow stiffness or hypomobility. Herein, we present a case of a 31-year-old patient admitted to our department with complaints of swelling and erythema in the right elbow. An X-ray image revealed a triangular accessory bone with rounded edges, which was diagnosed as a Patella cubiti in combination with olecranon bursitis. Knowledge of this rare elbow abnormality is paramount for orthopedic surgeons and roentgenologists in their daily medical practice.

Un hueso sesamoideo en la articulación del codo es una rara variación anatómica descrita como Patella cubiti. Aunque esta variación se conoce desde hace siglos, su etiología exacta aún no está clara. Se han propuesto hipótesis congénitas, de desarrollo y traumáticas. Rara vez causa manifestaciones clínicas que no sean rigidez o hipomovilidad del codo. Presentamos el caso de un paciente de 31 años que ingresó en nuestro servicio por presentar tumefacción y eritema en el codo derecho. Una imagen de rayos X reveló un hueso accesorio triangular con márgenes redondeados, que se diagnosticó como una Patella cubiti en combinación con bursitis del olécranon. El conocimiento de esta rara anomalía del codo es fundamental para los cirujanos ortopédicos y los médicos radiólogos en su práctica médica diaria.

Olecranon Fracture through Persistent Olecranon Apophysis in a 21-Year-Old Male: A Case Report and Systematic Review of the Literature.

Traumatic fractures involving an ununited olecranon apophysis in adults have been rarely documented in the literature. We present the case of a 21-year-old male wrestler with an elbow injury after a fall. Imaging revealed an acute fracture of the olecranon with sclerotic rounded edges indicating an injury through a persistent olecranon apophysis. Open reduction and internal fixation was performed with plate fixation and bone grafting with radiographic and clinical healing at 6 weeks. Review of the literature revealed 5 case reports showing high rates of non-union with tension band constructs while plate and screw fixation had no incidence of nonunion. Fractures through an ununited olecranon apophysis are successfully treated with plate and screw fixation with bone grafting.

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.(AU)

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.

The C342R mutation in FGFR2 causes Crouzon syndrome with elbow deformity.

Crouzon syndrome is an autosomal dominant craniosynostosis syndrome caused by mutation in the fibroblast growth factor receptor 2 (FGFR-2). Numerous findings from animal studies imply a critical role for FGFRs in the regulation of skeletal development. Here, we report 2 unrelated patients with Crouzon syndrome accompanied by elbow deformity. Subsequently, we analyzed the sequence of the FGFR2 gene and found that both of the patients carried the Cys342Arg mutation. The findings suggest that the C342R mutation in FGFR2 may cause Crouzon syndrome and elbow deformity in Chinese patients.

Patella cubiti: a case report and literature review.

Patella cubiti is a rare elbow anomaly in which either the entire olecranon or a part of it remains separate from the proximal ulna. Pain and stiffness are the usual presenting symptoms while some patients are diagnosed incidentally following a minor trauma. Our case report is of a 24-year-old male wrestler with bilateral patella cubiti which was painful on right side and asymptomatic on the left. We also mention an additional cause of pain in patella cubiti-intra-articular loose bodies. These loose bodies were removed surgically and the patient remained asymptomatic at 6-months follow-up. Presence of growth disturbance in the secondary epiphyseal centre of first lumbar vertebra supports the 'developmental theory' of origin of patella cubiti. A compilation of data available in the literature on patella cubiti has been included.

Isolated avulsion of the medial head of the triceps tendon: an anatomic study and arthroscopic repair in 2 cases.

PURPOSE: The purpose of this study was to determine the area and characteristics of the triceps tendon footprint on the olecranon, with special attention to the medial head insertion. The secondary goal was to report 2 cases of isolated avulsions of the medial head of the triceps tendon treated successfully with arthroscopic repair. METHODS: Fifteen cadaveric upper extremities were examined to investigate the triceps tendon insertion, and two case reports of an arthroscopic repair technique are described. RESULTS: In 8 specimens (53%) there was a separate insertion of the medial head of the triceps tendon on the olecranon, which was deep to the long and lateral head insertions. The mean area of the medial head insertion was 44 mm(2), and the mean area of the combined long and lateral head insertions was 115 mm(2). In 7 specimens (47%) the long, lateral, and medial heads of the triceps inserted together and had a mean area of 134 mm(2). Although the 3 heads of the triceps inserted together, the medial head tendon fiber orientation was still directed deep to the long and lateral heads. At 2 years' follow-up, both patients described no pain, had better strength, and had improved Disabilities of the Arm, Shoulder and Hand scores and Mayo Elbow Performance Scores. CONCLUSIONS: We have determined the characteristics of the distal triceps tendon footprint and the insertional orientation on the olecranon. For cases with an isolated avulsion of the medial head of the triceps tendon, an arthroscopic repair technique is described. LEVEL OF EVIDENCE: Level IV, anatomic study and therapeutic case series.