You are not my orthopedist. But you might as well be.
July 23, 2013 6:54 PM   Subscribe

Nine months ago, I fell down and split my kneecap into two parts. Or at least, I thought I did. After several months of it failing to fuse back together, my doctors are suggesting that the kneecap was already in two parts (bipartite patella) before I injured it. Is there a way to tell that this is true (without prior x-rays)?

I only have the x-rays from the day of the injury (and x-rays taken a week later, and then every three months since then). Is it possible to tell from these whether the injury actually caused my kneecap to split in two, or whether it was congenitally bipartite to begin with?
posted by Cardinal Fang! to Health & Fitness (5 answers total)
 
IANAD. Idk if the X-rays would help, but might an MRI taken now show if you have (as described in the link) a piece of fibrous tissue that exists where most people have solid bone?
posted by toodleydoodley at 7:10 PM on July 23, 2013


Response by poster: toodley, my doctors are saying that the new injury probably DID break the fibrous tissue between the bones, which is how a bipartite patella would break. So, I can't use that to tell if the bones were separated before...
posted by Cardinal Fang! at 7:20 PM on July 23, 2013


If you don't trust the doctors you have, they should be willing to refer you to an independent physician who can answer this question. I think the term here is "second opinion."
posted by d. z. wang at 8:05 PM on July 23, 2013


Response by poster: dzwang, that's actually part of what I am asking. Is it possible for a doctor - another doctor, not one somewhat vested in making me go away - tell from the initial x-rays whether the break is new or bipartite? If I'm hearing that there is no way to tell from the x-rays, then I probably will not pursue a second opinion.

BTW, in this new day and age, each opinion is costing me a lot of money :-). So I'm not pursuing them lightly.
posted by Cardinal Fang! at 8:39 PM on July 23, 2013


IANAD or orthopedist or anything clinical whatsoever. I do love a good mystery medical question, and for ones like this, I turn to Pubmed (click to go straight to results for the search bipartite patella diagnosis). Few of the manuscripts from this particular search are freely available, but you can read the abstracts and get an idea about how clinicians think about this.

As far as whether a doctor would be able to tell--one of the papers said "Review of his radiographs revealed separation of bipartite fragment from the inferior pole of his right knee. The appearance was different from that expected of a fracture in that the fragment was rounded with well defined cortical edges." This suggests to my non-clinical brain that a good radiologist/doctor/whatever would be able to distinguish some characteristics of a regular break vs a break of a bipartite bone. One thing you might note from this selection of papers (at least from the titles and abstracts) is that it's not totally unheard of to fracture a bipartite patella, and it doesn't seem like just because it's bipartite that means it won't heal--it seems like it might, however, require a different treatment strategy.

All of that said, years ago I broke my (non-bipartite) patella, and they pinned it together with two vertical pins and a figure 8 band to hold things together (all the metal was removed after 8-10 months I think). It was a BIG deal to heal and took a LONG time of immobility. That's my experience, and of course yours may be completely different based on the type of break and probably a billion other factors.
posted by gubenuj at 10:57 PM on July 23, 2013 [1 favorite]


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