trose45116
Expert
PREOPERATIVE DIAGNOSIS: Fracture displacement of the right patella.
POSTOPERATIVE DIAGNOSIS: Fracture displacement of the right patella.
PROCEDURES: 1. Open reduction internal fixation right patellar fracture and removal of infrapatellar bone structure.
2. Repair of extensor mechanism.
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: After discussing the procedure, the patient was transferred via gurney to the operative theater and placed under general anesthesia without difficulty or problems. She was draped and prepped in the usual sterile manner.
A midline incision was made. We were able to sharply dissect down through the subcutaneous tissue, where the tissue was divided longitudinally in the medial and lateral planes. We were able to identify the complete disruption of the extensor mechanism. We were able to identify the fracture site. The two small bony fragments were less than 1 cm in length, but there was complete disruption of the extensor mechanism. We were able to, at that point in time, attempt a repair. However, we realized the bone fragments were way too small for adequate repair and, therefore, we elected not to repair the bone structure. From the inferior pole of the patella, the fragments were removed. We were able to, at that point in time, freshen up the edges of the patella itself. Drill holes were replaced in the remaining distal third of the patella from distal to proximal. Using a modified Kessler suture, we were able to reapproximate the patellar tendon to the inferior pole of the kneecap itself. Excellent fixation was achieved, and once we had accomplished our repair, the knee was placed through a full and complete range of motion, and we were satisfied with that.
We irrigated. We reapproximated the retinaculum. Subcutaneous sutures then followed. Staples followed in the skin. The patient had a sterile dressing applied. She was placed in a knee immobilizer. Tourniquet was released. The patient was awakened from anesthesia, transferred via gurney, and taken to the recovery room stable.
POSTOPERATIVE DIAGNOSIS: Fracture displacement of the right patella.
PROCEDURES: 1. Open reduction internal fixation right patellar fracture and removal of infrapatellar bone structure.
2. Repair of extensor mechanism.
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: After discussing the procedure, the patient was transferred via gurney to the operative theater and placed under general anesthesia without difficulty or problems. She was draped and prepped in the usual sterile manner.
A midline incision was made. We were able to sharply dissect down through the subcutaneous tissue, where the tissue was divided longitudinally in the medial and lateral planes. We were able to identify the complete disruption of the extensor mechanism. We were able to identify the fracture site. The two small bony fragments were less than 1 cm in length, but there was complete disruption of the extensor mechanism. We were able to, at that point in time, attempt a repair. However, we realized the bone fragments were way too small for adequate repair and, therefore, we elected not to repair the bone structure. From the inferior pole of the patella, the fragments were removed. We were able to, at that point in time, freshen up the edges of the patella itself. Drill holes were replaced in the remaining distal third of the patella from distal to proximal. Using a modified Kessler suture, we were able to reapproximate the patellar tendon to the inferior pole of the kneecap itself. Excellent fixation was achieved, and once we had accomplished our repair, the knee was placed through a full and complete range of motion, and we were satisfied with that.
We irrigated. We reapproximated the retinaculum. Subcutaneous sutures then followed. Staples followed in the skin. The patient had a sterile dressing applied. She was placed in a knee immobilizer. Tourniquet was released. The patient was awakened from anesthesia, transferred via gurney, and taken to the recovery room stable.
