单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,髌骨骨折（英文版）课件,1,It is important to fully evaluate patella fractures on the AP x-ray as well as,the lateral x-ray.The AP x-ray demonstrates the number of fragments and,vertical splits in the sagittal plane that are not visible on the lateral x-ray.,It is important to fully evalu,2,It is important to fully evaluate patella fractures on the AP x-ray as well as,the lateral x-ray.The AP x-ray demonstrates the number of fragments and,vertical splits in the sagittal plane that are not visible on the lateral x-ray.,It is important to fully evalu,3,Lateral radiograph demonstrating complete separation of,the patella with loss of extensor mechanism.,Lateral radiograph demonstrati,4,A vertical midline incision is performed over the patella.,A vertical midline incision is,5,After coming through subcutaneous tissue,the patella,fracture is immediately evident.The clot and cancellous,bone edges are cleaned.,After coming through subcutane,6,A lamina spreader demonstrates the fracture site.,A lamina spreader demonstrates,7,PATELLA ARTICULAR,SURFACE,TROCHLEAR,GROOVE,PROXIMAL,DISTAL,The articular surface of the patella and trochlear groove are,evident upon flexion of the knee.,PATELLA ARTICULAR SURFACE TROC,8,RETINACULAR TEAR,With displaced patella fractures there are concomitant,retinacular tears medially and laterally.,RETINACULAR TEAR With displace,9,PATELLA ARTICULAR,SURFACE,TROCHLEA,After complete debridement and cleaning of the fractures,a,cannulated screw guidewire can be placed retrograde through,the fracture site,close and parallel to the articular surface.,PATELLA ARTICULAR SURFACE TROC,10,The drill is then used also in a retrograde fashion.,The drill is then used also in,11,The saggital plane split is seen when the distal fragment is flexed.,This fracture is fixed with a transverse lag screw that will not,interfere with the cannulated screws.,The saggital plane split is se,12,Using a clamp,the fracture is reduced.,Using a clamp,the fracture is,13,FRACTURE,REDUCTION,Using a clamp,the fracture is reduced.,FRACTURE REDUCTION Using a cla,14,A second clamp is necessary in this,case to maintain the reduction.,A second clamp is necessary in,15,Closeup of the complete reduction,using several clamps.,Closeup of the complete reduct,16,After the reduction is complete,the K-wires are visualized in the,lateral and AP planes,which are used to evaluate not only the,guidewire placement but also the reduction.,After the reduction is complet,17,Lateral and AP views.Notice that the lag screw is placed,between the inferior lateral and inferior central fragment,but does not extend into the fragment on the medial side,as,this would interfere with the placement of the K-wire.,Lateral and AP views.Notice,18,The two cannulated screws are placed over the guidewires.These,screws must be large enough to enable the tension band to be placed,through them.,The two cannulated screws are,19,Each manufacturer is different;the surgeon must be confident that,the cannulation of the screw will accommodate the cable or wire system.,Each manufacturer is different,20,The screw should be placed such that it is short of the end of the,bone.This is to avoid the cable or wire system from being injured,by the sharp threaded end of the screw.,The screw should be placed suc,21,The cable system is introduced through one screw looped around,anteriorly,then placed in the same direction through the second,screw.,The cable system is introduced,22,The two ends are pulled through a connector and underneath,the clamp,which remains in place during the tightening.,The two ends are pulled throug,23,In this case the Dahl-Miles system is used and the tightener,is connected to the two free ends after a fastener is attached.,In this case the Dahl-Miles sy,24,Lateral X-Ray,Lateral X-Ray,25,AP x-ray demonstrating the tightening,of the cable grip system.,AP x-ray demonstrating the tig,26,After the wire is sufficiently tightened and crimped,in place,it is trimmed very close to the sleeve.,After the wire is sufficiently,27,The retinaculum is then carefully repaired on both the,medial and lateral sides to afford stability and additional,support to the reconstruction.,The retinaculum is then carefu,28,Closeup of the final reconstruction.,Closeup of the final reconstru,29,Lateral radiograph demonstrating the reduction.Notice that the,screw tips are shy of the cartilage on the patella.The cable grip,system wraps around the bone and is not making a sharp angle,at the tip of the screw.,Lateral radiograph demonstrati,30,AP x-ray demonstrating the reconstruction using the cannulated,screws to fix the central distal fragment and the medial distal fragment,back to the proximal fragment.The distal lateral fragment is held with,a lag screw.After fixation,the knee is brought to a complete range of,motion to confirm stability and repeat radiographs are obtained.,AP x-ray demonstrating the rec,31,