Modified Ilizarov in difficult Fracture of the Patella. A case report

INTRODUCTION: Ilizarov technique yields satisfactory results in difficult situations. Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation. We are reporting one such case in a 27 years old male treated by modified Ilizarov technique. CASE REPORT: A 27-years old male with transverse fracture of the patella was fixed with tension band wiring. He indulged in heavy manual work including bicycling after 15 days of operation contrary to advice that led to loosening of implants and failure of reduction. He reported after 2 months of failure. A modified Ilizarov technique was contemplated. Implants were removed. After cleaning the margins, opposite olive wires (2 in each fragment) mounted in traction units were attached to two full rings, each fixed to distal femur and tibia. Sub-acute docking was done on the table followed by gradual docking till the fragments came in contact to each other. Compression was applied across the fracture site after confirmation of docking by X-ray at the rate of 0.25 mm every 3rd day till 1.0 mm of compression was achieved. Full weight bearing was possible immediately after surgery. Regular follow up was carried out to look for any pin site problems and loss of compression. Assembly was removed after X-ray confirmed sound healing after 2 months. Initially there was restriction of movements at the knee joint which improved gradually with physiotherapy. At one year follow-up, the patientcould squat completely. CONCLUSION: Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation Modified Ilizarov technique is beneficial for treating such a situation in terms of function and restoration of anatomy as it avoids soft tissue scarring which may follow in an attempt to do an open reduction. Gradual stretching of the soft tissue and subsequent controlled compression at the fracture site is the advantage of this technique.