ORIF - screw fixation
Indication summary: Displaced fractures
The treatment of choice is open reduction and internal fixation.
Anterior and lateral flake fractures may be associated with patellar dislocation. These fractures may be small osteochondral fragments and may be technically unfixable. Small fracture fragments may need to be excised, or washed out of the knee joint arthroscopically.
Displaced fractures should be fixed with sunken screws, or bioresorbable pins, to achieve anatomical restoration of the articular surface, permitting early active mobilization of the joint surface. Larger fragments that are not in the femoral trochlea may be addressed arthroscopically. Reduction and cannulated screw/absorbable pin fixation is performed under arthroscopic control.
- Displaced fractures
- Additional knee ligament injury
- Additional meniscial injury
- Patient not medically fit for surgery
- Local infection
- Open surgery offers possibility of treatment of associated knee derangements
- Direct anatomical reduction
- Early mobilization of the knee joint
- Lower incidence of osteoarthritis
- Risk of nonunion and avascular necrosis
- Risk of incorrect position of screws leading to impingement on patella
- Risk of failure of bioresorbable pins
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|