PATELLA [Case 2] · Cannulated Screws + Cerclage

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

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

Training Focus

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

Detailed Content

• Precise Anatomical Planning: Careful identification of fracture lines, bone teeth, and areas of greater bone mass for safe definition of implant positioning.
• Selective Periosteal Dissection: Technique limited to the fracture line, preserving bone vascularization and promoting consolidation.
• Progressive Reduction in High Tension Situations: Manual and forceps strategies to overcome muscle contractures and joint stiffness without generating secondary fractures.
• Strategic Use of Temporary X-Wires: Maintaining reduction in scenarios where immediate definitive fixation is not possible.
• Optimized Sequence of Cannulated Screws: Homogeneous compression by alternating tightening and prevention of opening of longitudinal lines.
• Treatment of Associated Longitudinal Fractures: Complementary fixation with transverse screws for structural protection of the patella.
• Guided Cerclage Glued to the Bone: Technique of passing through cannulated screws, avoiding soft tissue interposition.
• Controlled Knot Tying and Positioning: Strategies to minimize anterior prominence and reduce 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 comments on surgical decisions, difficulties encountered, and solutions adopted.

Material Included

Detailed PDF:

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

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