Description of Event or Problem · 1
DOCTOR WAS PERFORMING A RIGHT PATELLA OPEN REDUCTION INTERNAL FIXATION. THE FRACTURE WAS ACTUALLY PRETTY SIMPLE. THE SURFACE AREA OF THIS PIECE WAS PROBABLY ABOUT THE SIZE OF A QUARTER, BUT THERE WAS A VERY THICK CARTILAGE THAT WAS VISIBLE AND THE CARTILAGE LOOKED TO BE INTACT. HE WAS ABLE TO APPROXIMATE THIS TO THE BODY OF THE PATELLA WITH SOME REDUCTION CLAMPS AND A SUTURE THROUGH THE SOFT TISSUES ANTERIORLY. HE MADE SURE THAT HE REMOVED ALL OF THE PERIOSTEUM FROM THE FRACTURE SITE. HE THEN PLACED 2 K-WIRES ACROSS THE FRACTURE FRAGMENT AND INTO THE BED OF THE PATELLA, VERIFIED THE POSITION OF THE K-WIRES AND ADVANCED A COUPLE OF 4-0 CANNULATED SCREWS ACROSS THESE. X-RAYS SHOWED THAT WHEN THE SECOND SCREW WAS ADVANCED, ONE OF THE THREADS COMPLETELY DELAMINATED OFF OF THE SHAFT OF THE SCREW AND IT HAD MIGRATED INTO THE KNEE JOINT. HE IMMEDIATELY BACKED THIS OUT AND AS HE BACKED OUT, THE THREAD REMOVED ITSELF OUT OF THE KNEE JOINT, BUT THERE WERE SOME METAL FILINGS THAT WERE LEFT WITHIN THE PATELLA, RIGHT AT THE LEVEL OF THE CARTILAGE BONE BORDER ON THE INFERIOR SURFACE NEAR THE FRACTURE SITE. HE ELECTED NOT TO GO IN AND TRY TO REMOVE THESE PIECES AS IT WAS OBVIOUS THAT IT WAS NOT UP IN THE CARTILAGE AND WAS RIGHT AT THE BONE INTERFACE AND THEY ARE VERY SMALL PIECES. HE THEN REDIRECTED THE SECOND K-WIRE AND USED A NEW SYNTHES 4-0 CANCELLOUS PARTIALLY THREADED SCREW. HE WAS ABLE TO ADVANCE THAT AND GOT EXCELLENT PURCHASE AND REDUCTION OF THE FRACTURE.