Displaced patellar fractures associated with joint stiffness, preexisting deformity, and poor bone quality represent a significant technical challenge, particularly in achieving and maintaining reduction.

This training presents, in 4K video under a surgical perspective, a systematized approach to patellar osteosynthesis using cannulated screws associated with cerclage, focused on restoration of the extensor mechanism even in highly complex scenarios.

Training Focus

• Osteosynthesis of displaced patellar fractures
• Difficult reduction in a knee with flexion stiffness
• Use of cannulated screws associated with cerclage
• Strategies for associated longitudinal fractures
• Preservation of the extensor mechanism

Detailed Content

• Precise Anatomic Planning: Careful identification of fracture lines, bony interdigitations, and areas of greater bone mass to safely define implant positioning.
• Selective Periosteal Dissection: Technique limited to the fracture line, preserving bone vascularity and favoring consolidation.
• Progressive Reduction in High-Tension Situations: Manual and clamp-assisted strategies to overcome muscular contractures and joint stiffness without generating secondary fractures.
• Strategic Use of Temporary Crossed Wires: Maintenance of reduction in scenarios where immediate definitive fixation is not possible.
• Optimized Sequence of Cannulated Screws: Homogeneous compression through alternating tightening and prevention of opening of longitudinal fracture lines.
• Management of Associated Longitudinal Fractures: Complementary fixation with transverse screws for structural protection of the patella.
• Guided Cerclage Closely Applied to Bone: Technique of passage through the cannulated screws, avoiding interposition of soft tissues.
• Controlled Knot Tying and Knot Positioning: Strategies to minimize anterior prominence and reduce the future need for implant removal.
• Functional Preservation of the Extensor Mechanism: Planned longitudinal incisions in the quadriceps tendon to accommodate the cerclage without functional impairment.
• Intraoperative Technical Analysis: Detailed commentary on surgical decisions, encountered difficulties, and adopted solutions.

Included Material

Detailed PDF:

Technical document with a structured summary of the step-by-step surgical procedure, biomechanical principles of patellar osteosynthesis, indications for the implants used, strategies for difficult reduction, prevention of complications, and critical points for preservation of the extensor mechanism.

Enhance your decision-making and execution in complex patellar fractures. Enroll and incorporate a systematized technical approach into your surgical practice.