In order to prevent disruption of the medially based vascular supply to the patella34, a lateral parapatellar arthrotomy is then performed, fracture hematoma is evacuated, and the knee joint is irrigated. The patella is then inverted to permit direct visualization of fracture fragments and the articular surface33 (Figure 1). If further exposure or inversion is necessary, the arthrotomy can be extended superiorly with a cuff of quadriceps tendon left on the vastus lateralis for later repair. Anatomic reduction of the articular surface is then performed under direct visualization.
We have found that for large fragments, 2.0 threaded Krischner-wires are useful both as joysticks
and to maintain reduction when placed in interfragmentary fashion.