ORIF Patella
synonyms:
ORIF Patella CPT
- 27350 (patellectomy or hemipatellectomy)
- 27520 (closed treatment of patellar fracture, without manipulation)
- 27540 (open treatment of patellar fracture, with internal and/or partial or complete patellectomy and soft tissue repair)
ORIF Patella Indications
- Displaced transverse patella fracture
ORIF Patella Contraindications
ORIF Patella Alternatives
ORIF Patella Pre-op Planning
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
- Nonuion
- Infection
- Painful hardware
- CRPS
- DVT / PE
- We discussed the risks of surgery including but not limited to: infection, nonunion, malunion, loss of fixation, painful hardware, CRPS, DVT/PE, incomplete relief of pain, incomplete return of funtion and the risks of anesthesia including heart attack, stroke and death.
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
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