A very rare case of traumatic avulsion fracture of the fabella in a middle-age lady, presented as intermittent posterolateral localized knee pain accentuated by compression against the lateral femoral condyle and by active and passive knee extension, is illustrated. The accumulated chronic microtrauma of the osteoarthritic fabello femoral joint in this lady especially during the whip-kick of daily breaststroke swimming for over 30 yr, may precipitate a fabella stress fracture. Radiographs reveal bilateral fabellae with a left bipartite fabella as a stress fracture traversing it without displacement; this later became a completely displaced bipartite avulsion fracture after accidental knee hyperextension. Conservative treatment consisted of anti-inflammatory/analgesic cream, cryotherapy, TENS, strapping and avoiding knee hyperextension.
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