![]() ![]() c-arm in from contralateral side perpendicualr to bed.patient supine with small bump under ipsilateral thigh.cannulated screws with tension band biomechanically superior to kwire tension band. ![]() comminuted fractures can be treated with partial or total patellectomy with quadriceps or patellar tendon advancement.if extensor mechanism intact and nondisplaced or minimally displaced fracture can treat patients in knee extension brace or cast.may be mistaken for patella fracture (8% of population).examine for presence of bipartite patella (superolateral position).degree of displacement correlates with degree of retinacular disruption.evaluate lateral xrays for patella alta and degree of fracture displacement.document distal neurovascular status and associated injuries.note patellar defects, presence of effusion, open lesions.failure indicates lack of extensor mechanism.begin gentle range of motion exercises to knee at 2-4 wks.if fixation is solid, can allow patient to weight bear as tolerated with knee brace locked in extension.#2 Fiberwire to close medial and lateral retinacular tears if present.18G (#6/7) sternal wire under quadriceps and patellar tendons deep to kwires crossed over anterior patella in figure-8 pattern.alternatively, can place 3.5 or 4.0 cannulated screws across fracture line, travel from small fragment to large fragment and pass wire through screws.062 kwires parallel across primary fracture lines use small pointed reduction clamps to control fracture fragments, line them up, and then clamp with large pointed reduction clamp in center of patella out of way of hardware.small and large pointed reduction clamps for reduction.sharply dissect out fracture lines and debride.usually helpful to extend incision over patellar tendon and quad tendon. ![]()
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