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Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection
by Matjaz Veselko, and Matej Kastelec
JBJS Essent Surg TechVolume os-87(1 suppl 1):113-121
March 1, 2005
©2005 by The Journal of Bone and Joint Surgery, Inc.
Preoperative radiograph showing an avulsion fracture of the patellar pole.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The patient is placed in the supine position.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The straight midline skin incision starts approximately two fingerbreadths proximal to the displaced proximal fragment of the patella and runs distally to the tibial tuberosity.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The ruptured retinaculum on either side of the fracture, both fragments, and the patellar tendon are exposed.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Intraoperative photograph demonstrating placement of the interwoven suture.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The four posterior hooks of the basket plate are thrust through the patellar tendon, just distal to the suture line, so that the fragments are embraced by the basket.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
A 2.0-mm Kirschner wire is drilled through one of the central plate holes and through the patellar pole as posteriorly as possible.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The pole fragments within the plate are reduced and fixed with two large, pointed reduction forceps to the main fragment, and the Kirschner wire is drilled across the fracture into the
proximal fragment.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
One of the large, pointed reduction forceps, previously repositioned around the apex of the plate, compresses the plate and the pole fragments against the main fragment.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Fluoroscopic image showing the final position of the basket plate after fixation to the main fragment with four screws.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Intraoperative photograph showing the final position of the basket plate after coverage with soft tissue.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
The stability of fixation is checked by flexing the knee into full flexion before the wound is closed.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
Postoperative lateral radiograph demonstrating anatomic reduction of the fracture and a reduced position of the patella.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:113-121
©2005 by The Journal of Bone and Joint Surgery, Inc.
