Patella Fracture Fixation (ORIF)
A surgical procedure to realign and stabilise a fractured patella using internal fixation
The patella plays a crucial role in knee function by facilitating smooth movement of the joint and protecting it from direct trauma. Fractures of the patella can result from high-impact injuries, such as falls or vehicle accidents, and may lead to pain, instability, and difficulty bending or straightening the knee.
Common Reasons for ORIF of the Patella Surgery
- Displaced fractures where the bone fragments have moved out of alignment.
- Fractures involving multiple pieces of the patella (comminuted fractures).
- Open fractures where the bone pierces the skin.
- Inability to extend the knee or perform weight-bearing activities due to the fracture.
Goals of the Procedure:
- Restore proper alignment and structural integrity of the patella.
- Relieve pain and facilitate healing.
- Improve mobility and knee function.
Preparation for Surgery
A thorough pre-surgical evaluation is conducted by Dr Ben McGrath, including physical examination and imaging studies such as X-rays or CT scans to assess the extent and location of the fracture.
Key Steps in Preparation:
- Pre-Surgical Consultation: Discussion of the procedure, expected outcomes, and potential risks.
- Fasting Instructions: Patients may be required to fast for a certain period before surgery.
- Medication Adjustments: Some medications, particularly blood thinners, may need to be paused or adjusted.
Lifestyle Modifications: Quitting smoking and maintaining a healthy diet may improve healing and recovery outcomes.
What Happens During the Surgery?
The ORIF procedure is typically performed under general or regional anaesthesia.
Surgical Steps:
- Incision and Exposure: An incision is made over the knee to access the fractured patella.
- Reduction of the Fracture: The bone fragments are carefully realigned to their normal position.
- Internal Fixation: Devices such as screws, wires, or plates are used to stabilise the bone fragments and ensure proper healing.
- Closure: The incision is closed using sutures or surgical staples, and a sterile dressing is applied.
The procedure usually takes 1 to 2 hours, depending on the complexity of the fracture.
Understanding the Risks
As with any surgical procedure, ORIF carries some risks, including:
- Infection: At the incision site or within the joint.
- Blood Clots: Rare but possible in the legs or lungs.
- Implant Complications: Issues with the fixation devices, such as loosening or irritation.
- Delayed Bone Healing: Particularly in complex fractures.
- Pain or Stiffness: Residual discomfort or reduced range of motion.
Dr McGrath follows meticulous surgical protocols and utilises advanced techniques to minimise these risks.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Medications and icing are used to manage pain and swelling.
- Immobilisation: A knee brace or splint may be applied to protect the repair and limit movement.
- Hospital Stay: Patients typically stay in hospital for 1 to 2 days, depending on their recovery progress.
Discharge Instructions:
- Guidance on wound care and signs of infection to monitor.
- Instructions on managing weight-bearing activities and using assistive devices like crutches.
Rehabilitation and Recovery
Rehabilitation is essential for optimal recovery and to regain strength and mobility in the knee.
Phase 1: Early Recovery (Weeks 0–6)
- Goals: Protect the surgical site, reduce swelling, and begin gentle range-of-motion exercises.
- Activities: Non-weight-bearing or partial weight-bearing with crutches.
Phase 2: Intermediate Recovery (Weeks 6–12)
- Goals: Gradually increase weight-bearing activities and improve knee flexibility.
- Activities: Physiotherapy exercises focusing on strength and mobility.
Phase 3: Advanced Recovery (Months 3–6)
- Goals: Return to daily activities and work, with a focus on regaining full strength and stability.
- Activities: Progressive functional training, including low-impact exercises.
Long-Term Outcomes
ORIF surgery may provide long-term stability and functionality of the knee, allowing patients to return to normal activities. Success depends on:
- Adherence to physiotherapy and rehabilitation programs.
- Regular follow-up appointments to monitor healing progress.
- Maintaining a healthy lifestyle to support bone and joint health.
While many patients experience significant improvements in pain relief and knee function, individual outcomes may vary based on factors such as the severity of the fracture and adherence to post-operative care.