1. by Matjaz Veselko, and Matej Kastelec
Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection
by Matjaz Veselko, and Matej Kastelec
JBJS Essent Surg Tech
Volume os-87(1 suppl 1):
March 1, 2005
©2005 by The Journal of Bone and Joint Surgery, Inc.

2. Preoperative radiograph showing an avulsion fracture of the patellar pole.
Preoperative radiograph showing an avulsion fracture of the patellar pole. The main fragment is displaced proximally. Comminution of the pole fragment can be seen.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:
©2005 by The Journal of Bone and Joint Surgery, Inc.

3. The patient is placed in the supine position.
The patient is placed in the supine position. The knee is supported in a semiflexed position with use of a bolster. A tourniquet is used.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:
©2005 by The Journal of Bone and Joint Surgery, Inc.

4. 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.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

5. The ruptured retinaculum on either side of the fracture, both fragments, and the patellar tendon are exposed.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

6. 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.

7. 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.

8. 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.

9. Intraoperative photograph demonstrating placement of the interwoven suture.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:
©2005 by The Journal of Bone and Joint Surgery, Inc.

10. 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.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

11. A 2.0-mm Kirschner wire is drilled through one of the central plate holes and through the patellar pole as posteriorly as possible.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

12. 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.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

13. 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.
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. A 4.0-mm cancellous-bone screw is placed in the right central plate hole. The screwdriver is in place, indicating the direction of the screw, so that the second hole can be drilled parallel to the first.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:
©2005 by The Journal of Bone and Joint Surgery, Inc.

14. 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.

15. 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.

16. Fluoroscopic image showing the final position of the basket plate after fixation to the main fragment with four screws.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

17. Intraoperative photograph showing the final position of the basket plate after coverage with soft tissue.
Intraoperative photograph showing the final position of the basket plate after coverage with soft tissue. The retinaculum on the medial side has been sutured. Before the gap is closed completely, it is important to check for impingement of the hooks against the patellar groove and to bend them further against the patellar surface if needed.
Matjaz Veselko, and Matej Kastelec J Bone Joint Surg Am 2005;os-87:
©2005 by The Journal of Bone and Joint Surgery, Inc.

18. The stability of fixation is checked by flexing the knee into full flexion before the wound is closed.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.

19. Postoperative lateral radiograph demonstrating anatomic reduction of the fracture and a reduced position of the patella.
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:
©2005 by The Journal of Bone and Joint Surgery, Inc.