Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture

Arthroscopic Management for Bipartite Patella: A Systematic Review

Background:

Bipartite patella is a rare congenital condition that becomes painful following direct trauma or an overuse injury. If it remains painful despite nonoperative treatment, surgery may be warranted. The current gold standard is open fragment excision or lateral release; however, arthroscopic management is also possible.

Purpose:

To investigate the safety and efficacy of arthroscopic treatment of painful bipartite patella.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Using Medline and Embase, we systematically reviewed the literature as of March 8, 2020, using the subject headings “bipartite patella” and “arthroscopy” and related key terms. All levels of evidence involving human studies in English were included. Articles were excluded if only the abstract was published or the study was related to nonsurgical treatment or nonrelated diagnoses. Data related to journal/article information, demographic/clinical data, arthroscopic technique, length of follow-up, treatment outcomes, and complications were extracted.

Results:

Eleven articles with 43 patients were included in the review. Most patients (n = 34; 79%) underwent arthroscopic lateral release, while 16% (n = 7) had arthroscopic excision of the accessory fragment and 5% (n = 2) had arthroscopic excision and release. All patients except for one, who experienced postoperative trauma, were pain-free after arthroscopic treatment and were able to return to sports after a mean 2.6 months.

Conclusion:

This review demonstrated that arthroscopic management of painful bipartite patella is a safe and effective alternative to open surgical excision or release. However, all articles were case studies or small case series, owing to the rarity of the condition. In the future, higher-level studies comparing arthroscopic techniques and postoperative rehabilitation programs should be performed.

The forensic value of smile photograph and medical radiograph analysis in identifying human skeletonized remains: a case report

Background

Identifying human remains which are skeletonized, carbonized, disfigured, or fragmentized is a common task for forensic anthropologists and odontologists.

Case presentation

A case of unknown skeletonized remains is reported in this investigation, which was found in a mass grave in Damascus Countryside governorate, Syria, in 2017. The post-mortem (PM) examination of bones and teeth was completed in al-Muwasat University Hospital in Damascus. Skull and pelvic bones showed Caucasoid male traits: the fourth rib and teeth examination estimated the age to be between 30 and 40 years, and the long bone estimated the stature in centimeters to be between 172 and 179. Intact dentition with tiny fracture in the incisal edge of the upper right central incisor—along with pathological fracture of right patella—was noted. Matching with ante-mortem (AM) smile photograph and radiograph of the right knee led to positive identification.

Conclusions

The present study highlights the importance of maintaining and storage of medical radiographs or any other records that show the teeth or bones of the person.