In most cases, the first three fuse at 15–18 years, whereas the base part fuses to the scapular spine at 12 years. Such failure to fuse occurs in between 1% and 15% of cases. It rarely causes pain. Vertebral column
An Oppenheimer ossicle is found in approximately 4% (range 1–7%) of individuals. It is associated with the facet joints of lumbar spines. It usually occurs as a single, unilateral ossicle at the inferior articular processes, but can also occur at the superior articular processes. Knee
The fabella is present in 10% to 30% of individuals. See also
Accessory muscle


== References ==
Digital health interventions have been shown to be particularly effective in providing combined therapy to manage PCOS through both lifestyle changes and medication.For those women that after weight loss still are anovulatory or for anovulatory lean women, then the medications letrozole and clomiphene citrate are the principal treatments used to promote ovulation. Previously, the anti-diabetes medication metformin was recommended treatment for anovulation, but it appears less effective than letrozole or clomiphene.For women not responsive to letrozole or clomiphene and diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF).Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "ovarian drilling" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH. (Ovarian wedge resection is no longer used as much due to complications such as adhesions and the presence of frequently effective medications.) There are, however, concerns about the long-term effects of ovarian drilling on ovarian function. Mental Health
Although women with PCOS are far more likely to have depression than women without, the evidence for anti-depressant use in women with PCOS remains inconclusive.