Basics of patella fracture and tension band wiring

1. Patella
Fracture

2. superior pole has attachment to
quadriceps tendon p
largest lateral
retinaculum are the
expansions of quadriceps

4. mechanism
suspect
types
treat
treatment options
variables that should be considered

5. • INDIRECT
contraction in a semi-flexed
damage to extensor
retinaculum.
• DIRECT
direct impact
communitted

6. suspect
dashboard
•Unable to do active SLR
Hip dislocation

7. bipartite patella
osteochondral fractures orVertical

8. Why should we treat
• Restoration of the Articular
•Preservation of functional integrity and
Strength of the extensor mechanism

9. •Tension band wiring
•Modified tension band wiring

10. •Displaced
•Type
(tell the patient to
perform active SLR)

11. •Non displaced
< 2mm
<3mm
•Intact Retinaculum
SLR

12. Protocol
in extension

13. •Loss of knee extension

14. •Risk of prepatellar bursitis

15. should be avoided.
should be preserved
•Inter-fragmentary screw

16. Attempt should always be made to
preserve as much patella is possible

17. Tension Band wiring
•Better than cerclage wire

18. • Convert tensile forces into compressive forces
• Prestressed
•DYNAMIC COMPRESSION
5 times

19. •Loss of extensor strength

21. • Check SLR
• Look for fragments
• Rule out bipartite patella
• Check for communition
• Tension band wiring in extension
• Better use tension band wiring instead of cerclage wire
•DO NOT FIX IN FLEXION
•DO REPAIRTHE RETINACULUM