Fragment excision or reconstruction

In some instances, comminution may be present on the medial or lateral aspect of the patella, but the patellar mechanism remains intact. For these patients, the removal of these small comminuted fragments will suffice.

The patient is positioned in dorsal recumbency. The pelvic limb is extended.

A sagittal or parasagittal skin incision is made over the patella.

A lateral parapatellar or medial parapatellar dissection is performed along the patellar ligament and patella proximally to the quadriceps muscle.

The direction of the approach is based on the location of the comminution.

Non-reconstructible small fragments are removed.

Non-reconstructible fragments are removed

The joint is lavaged to flush out any remaining small bone fragments.

The stifle joint is sutured using monofilament absorbable suture material. The wound is closed in layers.

General considerations

Limb disuse after the repair of a patellar fracture is unusual. Most dogs start weight bearing within 3 days of surgery.

The focus of physical rehabilitation is to:

Avoid loss of stifle joint motion, particularly loss of extension
Avoid excessive stress on the surgical repair during the healing period
Promote low-impact weight bearing pelvic limb exercise

The stifle joint is protected and partially immobilized if deemed necessary for approximately 14 days.

Cryotherapy and passive range of motion are indicated but not possible if immobilization is used.

Activity is limited to leash walks until bone healing is radiographically evident.

Phase 1: 1-3 days after surgery

The aim is to reduce the edema, inflammation and pain using cryotherapy anti-inflammatory and analgesic medications.

Gentle passive range of motion of the hip and stifle joint can be initiated to promote mobility and joint health.

Phase 2: 4-14 days after surgery

The aim is to resolve the hematoma, edema, control pain and prevent muscle contracture.

Anti-inflammatory and analgesic medications may still be needed.

If the dog is not starting to use the limb within a few days after surgery, re-evaluation is recommended.

Phase 3: 14 days-8 weeks after surgery

Rehabilitation therapy is continued.

10-14 days after surgery the sutures are removed.

Radiographic assessment is performed every 4-8 weeks until bone healing is confirmed.

Ventrodorsal radiograph of a 6 months-old female whippet. An ill-defined bone opacity is visible on the lateral aspect of the left patella.
That bone opacity is not visible on the mediolateral radiographic view.