Name of the Procedure:

Open Treatment of Patellar Fracture with Internal Fixation and/or Patellectomy and Soft Tissue Repair

Summary

This surgical procedure involves the repair of a broken kneecap (patellar fracture). The surgeon may use metal hardware to fix the bone pieces together or may remove part or all of the kneecap if it's severely damaged. Soft tissues around the kneecap are also repaired as needed.

Purpose

This procedure addresses fractures of the kneecap, which can result from trauma such as falls or direct blows. The goals are to restore the function of the knee joint, alleviate pain, and allow the patient to return to normal activities.

Indications

• Severe pain and swelling in the knee
• Difficulty or inability to move the knee
• Visible deformity or irregular bump at the knee
• X-ray or CT scan showing a fractured kneecap
• Failure of non-surgical treatments (e.g., casting, bracing)

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or stopping certain medications as directed by the doctor
• Pre-operative imaging tests such as X-rays or CT scans
• Blood tests and possibly an EKG to assess fitness for surgery

Procedure Description

1. The patient is given anesthesia (general or spinal).
2. An incision is made over the knee to expose the fractured patella.
3. The fractured pieces are aligned properly.
   • Internal fixation: Screws, wires, or plates are used to hold the bone fragments together.
   • Patellectomy: In cases where the bone is too damaged, partial or complete removal of the patella is performed.
4. Soft tissue repair: Tendons, ligaments, or other soft tissues around the kneecap are repaired.
5. The incision is closed with stitches or staples and covered with a sterile dressing.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection at the incision site
• Blood clots in the leg
• Nerve or blood vessel damage
• Failure of the hardware (screws, plates)
• Persistent pain or stiffness
• Re-fracture of the knee

Benefits

• Pain relief
• Restoration of knee function
• Ability to engage in daily activities and physical exercise
• Improved stability and strength of the knee

Recovery

• Hospital stay for 1 to 3 days post-surgery
• Use of knee brace or immobilizer initially
• Physical therapy to regain movement and strength
• Gradual return to weight-bearing activities over several weeks
• Follow-up appointments for wound check and removal of sutures

Alternatives

• Non-surgical treatments: Casting, bracing, physical therapy
• Per-cutaneous pinning: Less invasive, only suitable for simpler fractures
• Pros of non-surgical options: Lower risk of infection, no anesthesia risks
• Cons: Longer immobilization period, possible incomplete healing

Patient Experience

• During: Under anesthesia, the patient feels no pain.
• Immediately after: Some pain and swelling at the surgical site, managed with pain medications.
• Short-term: Limited mobility, possibly a brace or crutches.
• Long-term: Gradual improvement in knee function with physical therapy, complete recovery may take several months.