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A case of patellar fractures in monozygotic twin gymnasts.

Beamish AJ, Roberts GL, Cnudde P - Sports Med Arthrosc Rehabil Ther Technol (2012)

Bottom Line: These patients presented 14 months apart with almost identical history and clinical findings.Both had an intense training regime involving over 30 hours per week of load-bearing exercise.An excellent functional result was observed in both patients with return to full activity at 8 weeks.This is the first published case of identical injury to the patella in monozygotic twins.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Orthopaedic Surgery, West Wales General Hospital, Hywel Dda NHS Trust, Dolgwili Road, Carmarthen, Wales, SA31 2AF, UK. peter.cnudde@tiscali.co.uk.

ABSTRACT
We present a case of near identical patellar fractures in adolescent monozygotic twins who are both high-level competitive gymnasts. These patients presented 14 months apart with almost identical history and clinical findings. Both had an intense training regime involving over 30 hours per week of load-bearing exercise. Clinical and radiological examinations suggested avulsion or sleeve fracture of the inferior pole of the patella with minimal displacement. Diagnoses of patellar stress fracture with avulsion of the distal pole and symptomatic bipartite patella could not be reliably excluded. Both fractures were treated conservatively with immobilisation of the knee in extension. An excellent functional result was observed in both patients with return to full activity at 8 weeks.This is the first published case of identical injury to the patella in monozygotic twins. A significant genetic influence on bone mineral density (BMD) has been reported and low BMD is associated with increased susceptibility to fracture. These injuries corroborate a genetic influence on susceptibility to fracture. There is a requirement for further work to investigate genetic factors influencing susceptibility to fracture.

No MeSH data available.


Related in: MedlinePlus

Plain film radiographs of Case 1 at 17 months.
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Figure 4: Plain film radiographs of Case 1 at 17 months.

Mentions: Clinical examination of his knee revealed a small effusion with tenderness at the inferior pole of the patella. He was unable to straight leg raise because of pain. Initial plain film radiography (Figure1) demonstrated a fracture of the inferior pole of the patella with minimal displacement. Magnetic resonance imaging showed a distinct separation of the inferior pole of the patella (Figure2) and bone marrow oedema (Figure3). The knee was immobilised in extension in a brace for a period of 5 weeks, following which he was found to be pain-free. He gradually returned to activity and by 8 weeks had resumed his normal training regime. Plain film radiography at 17 months post injury showed complete union of the patella (Figure4).


A case of patellar fractures in monozygotic twin gymnasts.

Beamish AJ, Roberts GL, Cnudde P - Sports Med Arthrosc Rehabil Ther Technol (2012)

Plain film radiographs of Case 1 at 17 months.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539963&req=5

Figure 4: Plain film radiographs of Case 1 at 17 months.
Mentions: Clinical examination of his knee revealed a small effusion with tenderness at the inferior pole of the patella. He was unable to straight leg raise because of pain. Initial plain film radiography (Figure1) demonstrated a fracture of the inferior pole of the patella with minimal displacement. Magnetic resonance imaging showed a distinct separation of the inferior pole of the patella (Figure2) and bone marrow oedema (Figure3). The knee was immobilised in extension in a brace for a period of 5 weeks, following which he was found to be pain-free. He gradually returned to activity and by 8 weeks had resumed his normal training regime. Plain film radiography at 17 months post injury showed complete union of the patella (Figure4).

Bottom Line: These patients presented 14 months apart with almost identical history and clinical findings.Both had an intense training regime involving over 30 hours per week of load-bearing exercise.An excellent functional result was observed in both patients with return to full activity at 8 weeks.This is the first published case of identical injury to the patella in monozygotic twins.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Orthopaedic Surgery, West Wales General Hospital, Hywel Dda NHS Trust, Dolgwili Road, Carmarthen, Wales, SA31 2AF, UK. peter.cnudde@tiscali.co.uk.

ABSTRACT
We present a case of near identical patellar fractures in adolescent monozygotic twins who are both high-level competitive gymnasts. These patients presented 14 months apart with almost identical history and clinical findings. Both had an intense training regime involving over 30 hours per week of load-bearing exercise. Clinical and radiological examinations suggested avulsion or sleeve fracture of the inferior pole of the patella with minimal displacement. Diagnoses of patellar stress fracture with avulsion of the distal pole and symptomatic bipartite patella could not be reliably excluded. Both fractures were treated conservatively with immobilisation of the knee in extension. An excellent functional result was observed in both patients with return to full activity at 8 weeks.This is the first published case of identical injury to the patella in monozygotic twins. A significant genetic influence on bone mineral density (BMD) has been reported and low BMD is associated with increased susceptibility to fracture. These injuries corroborate a genetic influence on susceptibility to fracture. There is a requirement for further work to investigate genetic factors influencing susceptibility to fracture.

No MeSH data available.


Related in: MedlinePlus