|
|
synonyms:Patella Fracture ORIF, patellar fracture ORIF, knee cap ORIF
ORIF Patella CPT
ORIF Patella Indications
- Displaced transverse patella fracture
ORIF Patella Contraindications
ORIF Patella Alternatives
ORIF Patella Pre-op Planning
- Ensure appropriate screws and wires are available. 4.0 cannulated screws.
- For transvers fractures; fully threaded headless screws placed 5mm away from the anterior cortex with and anterior wiring provides stronger fixation than headless or partially threaded screws and screws placed 10mm from the anterior cortex. (Chen C, BMC Musculoskeletal Disorders 2019)
ORIF Patella Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- General endotracheal anesthesia
- Supine position on radiolucent OR table. All bony prominences well padded.
- Examination under anesthesia.
- Well-padded tourniquet high on the thigh.
- Prep and drape in standard sterile fashion.
- Vertical midline incision.
- Expose fracture site, medial and lateral retinaculum.
- Fracture reduced with reduction forceps. Reduction judged based on palpation of articular surface and c-arm images.
- Fixation provided with 4.5mm cannulated screws and tension band created with #2 fiberwire suture placed through the cannulated screws.
- Severely comminuted fractures require cerclage fixation (wire/suture)
- Free osteochondral fragments require repair or excision.
- Repair medial and lateral retinaculum.
- Irrigate.
- Close in layers.
ORIF Patella Complications
ORIF Patella Follow-up care
- Post-op: knee brace locked in extention, WBAT in brace
- 7-10 Days: Wound check, confirm reduction on xray. Consider allowing knee ROM to some degree based on stability of fixation at surgery.
- 6 Weeks: Evaluate xrays for union. Advance ROM
- 3 Months: progress with ROM and strengthening
- 6 Months: review xrays, return to full activity / sport
- 1Yr: f/u xrays, assess outcome.
ORIF Patella Outcomes
ORIF Patella Review References
- Melvin JS, JAAOS 2011;19:198
- °
|
