An arthroscopic assisted minimally invasive approach can be used for some fractures.
The stifle is extended.
The fragments are temporarily anatomically reduced and stabilized using small pointed reduction forceps.
A K-wire is introduced centrally from the smaller fragment, cranial to the articular cartilage. A power drill is used at low speed (less than 300 rpm), using irrigation to minimize heat generation. As a guideline, the dimension of the K-wire for a German shepherd is 0.062'' (1.55 mm). Smaller K-wires are used in medium and small breeds. For example, 0.045'' (1.15 mm) is used in a border collie, and a 0.032'' (0.8 mm) is used in a miniature poodle or a cat.
Both ends of the K-wire should be accessible. 2-3 cm of K-wire should be accessible to facilitate wire placement and K-wire bending.
Orthopedic wire is wrapped in a figure of 8 pattern over the ends of the K-wire and twisted. As a guideline, the dimensions of the wire for a German shepherd breed is 18 gauge (1.25 mm). Smaller wires are used in medium and small breeds. For example, 20 gauge wire (1.0 mm) is used in a border collie, and a 22 gauge wire (0.8 mm) is used in a miniature poodle or a cat.
Note: The K-wire is directed perpendicular to the main fracture line, making sure to avoid the articular surface. The K-wire should be placed as caudal as possible, to minimize distraction of the articular surface.
The articular surface is evaluated to make sure that it is anatomically reduced.
The K-wire ends are cut and bent away from the articular surface.
The stifle joint is sutured using monofilament absorbable suture material. The wound is closed in layers.
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