Appropriate antibiotic prophylaxis should be given before inflating the tourniquet. A sterile bump can be placed behind the knee, which allows the knee to flex 15 to 20 degrees. Before inflating the tourniquet, the quadriceps is pulled distally to ensure that it is not trapped under the tourniquet, which can displace the patella proximally, making reduction more difficult. The limb is exsanguinated with a sterile Esmarch, and the tourniquet inflated to a pressure appropriate for the size of the leg and the patient’s blood pressure. conducted a study of 30 patients who suffered from a fracture of the patella and were treated by open reduction and internal fixation. The patient is prepped in a standard fashion, and the leg is draped free by using an extremity drape. Regional nerve blocks (femoral nerve block) can be very helpful to control postoperative pain. The procedure can be done under a general or spinal anesthetic. A tourniquet is placed high on the involved thigh. Because there is a tendency for the leg to externally rotate, a small bump can be placed under the ipsilateral hip. Internal fixation refers to the fixation of screws and /or plates to enable or facilitate healing. Open reduction refers to open surgery to set bones, and is necessary for some fractures. The patient is positioned supine on a standard operating table. Open Reduction and Internal Fixation (surgical) - Wikipedia (ORIF) of the patella is a surgical procedure to treat a fractured patella (knee cap). Therefore, whenever possible, the patella should be repaired rather than excised. This can lead to instability of the knee, extension lag, atrophy of the quadriceps, and loss of extension strength. Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. Patellectomy results in the loss of the patellar fulcrum, a decrease in the moment arm, and relative lengthening of the quadriceps. The importance of the patella for normal knee function cannot be overestimated. Forces measured at the patellofemoral articulation can be over seven times body weight during routine activities such as stair climbing and squatting. It is this articulation that acts as a fulcrum for extension. The undersurface of the patella, which articulates with the notch of the femur, has the thickest cartilage found in the body. The quadriceps muscle, extensor retinaculum, along with the iliotibial band, participates in knee extension. Traction forces that pull the patella cephalad are the result of several different vectors caused by contraction of the quadriceps muscle. The patella’s position in the body and the nature of its role in lower-limb function cause it to be susceptible to injury.
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