Kneecap Fractures (Patella Fractures): Fixation With a Plate and Braided Suture

Kneecap Fractures (Patella Fractures): Fixation With a Plate and Braided Suture

This surgical video demonstrates fixation of a kneecap fracture with a plate and braided suture. Here, we see a right knee with a large transverse, or horizontal, fracture through the patella, or kneecap. The surgeon has already made a large incision along the front of the knee.

The surgeon first repositions the broken bone pieces back together with surgical clamps and inserts guidewires into the broken bone pieces from the bottom of the kneecap to temporarily hold the pieces in place. The surgeon uses a scalpel to make small cuts where the guidewires are inserted, and uses a measuring instrument to measure the wires to determine the length of metal screws that will be needed.

The surgeon then passes the guidewires all the way through the kneecap, and then places a reamer over each wire to drill tunnels through the kneecap. The appropriate size screws are inserted over the wires through the tunnels. The surgeon then cuts the guidewires and slowly pulls them out while passing flat braided suture through the center of 1 of the screws.

The suture is then crossed over the front of the kneecap and passed through the center of the other screw. The surgeon then inserts the free end of the suture through the wire loop attached to the end of the suture to complete an X shape. In some cases, a metal plate may also be placed on top of the kneecap under the sutures for further compression.

The ends of the sutures are passed through a tensioning instrument that tightens the sutures on top of the plate. Once correct tension is achieved, the surgeon drills screws into the holes in the plates through the kneecap to lock the plate onto the bone. Final tension is applied to the sutures, and the surgeon ties a knot to secure the sutures in place. The surgeon passes the ends of the sutures through nearby soft tissue to help the knot lay flat. The sutures are then cut off.

Here we see the final fixation of the kneecap on x-ray. The surgeon will close the skin incision with sutures and the procedure is complete.