Salvage procedure
1. General considerations
Acute patella fractures can be reduced. Chronic patella fractures may not be reducible.
The fixation method must resist the large tension forces constantly acting on the patella.
Every effort should be made to reconstruct the patella. If reconstruction is not possible, a partial or complete patellectomy is performed as a salvage procedure.
Partial patellectomy is more likely to be clinical successful than complete patellectomy, as it preserves the extensor lever arm. However, both have an unpredictable clinical outcome.
2. Preparation and approach
The patient is positioned in dorsal recumbency. The pelvic limb is extended.
The direction of the approach is based on the location of the comminution.
3. Partial patellectomy
4. Total patellectomy
A detailed description of tendon repair techniques and postoperative protection are beyond the scope of this module.
5. Closure
6. Aftercare
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.
Physical rehabilitation
Limb disuse is more likely to occur after a patellectomy than patellar fracture repair.
The leg is immobilized for up to 6 weeks. Therapeutic exercises are initiated 6 weeks after surgery.
