Patella Cubiti : About a Case and Review of the Literature by Drs. Bensaka Mohammed in Journal of Clinical Case Reports, Medical Images and Health Sciences

Patella Cubiti : About a Case and Review of the Literature by Drs. Bensaka Mohammed in Journal of Clinical Case Reports, Medical Images and Health Sciences

Abstract:

Patella cubiti is a very rare anomaly which is characterized by the non-union of the olecranon to the proximal ulna. We report a 27-year-old patient admitted for elbow trauma whose diagnosis revealed patella cubiti, confusing it with an olecranon fracture. The patient underwent resection of the bone fragment. At 3 months after the operation, the patient felt satisfied because the foreign body he felt at the elbow had disappeared.

Key Words: Elbow, olecranon, congenital anomaly.

Introduction:

The congenital nonunion of the olecranon, which Habbe called “patella cubiti,” is a very rare anatomical variation [1]. In a typical case, the entire olecranon or part of it is separated from the proximal ulna, the bony edges are regular and smooth with a cortical outline on each side. Generally it is asymptomatic and its diagnosis is discovered incidentally. We report a patient whose diagnosis was made following a trauma.

Patient and observation:

This involved a 23-year-old patient, a smoker and an alcoholic, without a profession, admitted to our training for the management of an open trauma to the left elbow following a stabbing attack. Before the trauma, the patient felt a firm, painless mass on the posterior aspect of the left elbow, isolated from the olecranon. This non-symptomatic mass had not been the subject of any exploration. On physical examination of the left elbow, we noted a woundof approximately 3 cm on the posterolateral aspect of the elbow, no vascular-nervous damage, nor impairment of mobility of the elbow. Frontal and lateral X-rays of the left elbow showed a bony fragment with a regular edge next to the olecranon (Figure 1). The diagnosis of olecranon fracture is made and surgery is indicated. The patient was placed in the operating room in lateral decubitus position with arm on arm position. We widened the wound so that we reproduced the posterior approach to the elbow. Intraoperatively, we found an intact triceps tendon with a regular rounded bone fragment approximately 3 cm from the beak of the olecranon embedded in this tendon reminiscent of the anatomy of the patella (Figure 2). This bone fragment was resected at the patient's request. At 6 months follow-up, the patient did not complain of a change in the functionality of the elbow.

Discussion :

In 1903, Kienbock reported that a man had a large sesamoid bone resembling a patella near the olecranon. The majority of cases are reported in young males, but a few specific cases of patella cubiti are reported in females. A unilateral or bilateral bony fragment within the triceps tendon is called a patella cubiti; This condition is rarely encountered and several theories regarding its etiology have been proposed: separation of the epiphysis from the olecranon center in early childhood, leading to the independent development of this center. In our study, the etiology is not obvious because we did not find a notion of trauma prior to the trauma. Our review of the literature provides data for a better understanding of patella cubiti. Although the treatment of patella cubiti remains controversial, our suggestion is to avoid surgery only in patients who present only with elbow stiffness.

Conclusion :

Traumatic accidents to the elbow are common in childhood but x-rays are rarely taken; for this reason minor skeletal abnormalities are often not detected. These children may later present with “patella cubiti”. But the congenital origin is retained in the absence of etiological proof and life can be with a “patella cubiti”.

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