Abstract

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The author reports a case of supracondylar process of the femur in a patient who presented with trauma to the left knee in a road traffic accident. The patient was not symptomatic and the process was detected incidentally while doing the trauma series radiographs. Hence no intervention was suggested to the patient.

Introduction

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Supracondylar process of the humerus is not an uncommon finding, with most of the cases found incidentally while radiographs are done for trauma. The process with its attached Struthers ligament may compress the median nerve causing symptoms and signs of entrapment neuropathy or claudication in the forearm muscles on exertion.[1,2] There is only one case report of supracondylar process of the femur in the English medical literature.[1] When present in the humerus, this is thought to be the remnant of a vestigial muscle seen in certain climbing mammals.[2] The author reports an additional case of this curious radiological finding.

Case Report(s)

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A 29-year-old serving soldier was investigated for musculo skeletal injuries sustained in a car overturn. He was complaining of left knee pain for which a radiograph was done. There was no palpable swelling, and there was no tenderness in the knee. Antero posterior view of the left knee showed a bony projection pointing away from the knee joint, arising from the medial aspect of the left distal femur[Figure 1]. A CT scan of the left knee was done for confirmation[Figure 2]. CT scan showed no medullary continuity of the process with the medullary canal of the host femur.

Discussion

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Supracondylar process of the humerus is well documented in the medical literature, and is reported to be present in approximately 1% of the population.[1,2] There are not many reports of supracondylar process of the femur in the English literature.[1] Cohen reported an exostosis of the medial distal femoral shaft, which he described as “supracondylar process congenitalis of the femur”.[1]

These are thought to be vestigial processes which are present in the climbing mammals.

The supracondylar process of the humerus with the attached Struthers ligament is the remnant of a vestigial muscle, seen in certain climbing mammals.[2] In various mammals the semimembranosus muscle is inserted to the medial epicondylar process of the femur.[1] Dwight refuted this proposition of ancestral origin as early as 1895, and commented “the existence of a clearly marked process in a common ancestor and to assume that its great development in the anomaly is an accident of no significance”.[3]. He also mentioned that this is probably accidental, possessing no significance.[3]

A differential diagnosis which is considered is osteochondroma of the distal femur. Osteochondroma is distinguishable radiologically as they show continuity with the underlying medullary cavity of the bone of origin.[1,4] In our case the swelling was arising from the surface of the bone and there was no medullary continuity. Moreover there was no cartilage cap unlike in osteochondroma.

Since this was an incidental finding during imaging for skeletal trauma, an anomaly of which the patient was not aware of, no treatment was offered.

The authors declare that they have no conflict of interest to declare.

Conclusion

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Supracondylar process of femur is a rare anomaly, which is detected as an incidental finding while radiographs are taken for some other purpose.

Authors contribution(s)

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SS Suresh was responsible for diagnosis, management of the case, preparation of manuscript.

References

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1. Cohen SL. The supracondylar process congenitalis of the femur. JAMA 1979; 241: 565.
2. Lordan J, Rauh P, Spinner RJ. The clinical anatomy of the supracondylar spur and the ligament of Struthers. Clin Anat 2005; 18: 548-551.
3. Dwight T. The significance of anomalies. Am Nat1895; 29: 130-135.
4. James SL, Davies AM. Surface lesions of the bones of the hand. Eur Radiol 2006;16: 108-23.

Source(s) of Funding

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Nil

Competing Interests

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None

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