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PrinciplesAnatomicalstructuresCareshouldbetakenwiththeapproachforretrogradenailingasseveralanatomicalstructuresareatrisk.Themostimportantpotentialhazardisdamagetotheposteriorcruciateligament.Inaddition,cartilagefromtheweightbearingzonemaybedamagedifthewrongapproachisselected.Thiscanalsoleadtoafailuretoreducethefractureproperly,resultinginavarus/valgusmalpositionofthedistalmainfragment.TheanatomicallandmarkistheBlumensaat’sline,whichcorrespondstotheroofoftheintercondylarnotch.ProphylacticantibioticsAntibioticsareadministeredaccordingtolocalantibioticpolicyandspecificpatientrequirements.Manysurgeonsusegram-positiveprophylacticantibioticcoverforclosedfractures,addinggram-negativeprophylacticcoverforopenfractures.Alwaysrememberthatantibiotictherapywillnevercompensateforpoorsurgicaltechnique.SkinincisionMakealongitudinal2cmskinincision,justdistaltotheinferiorpatellarpole,overthemidlineofthepatellartendon.Soft-tissuehandlingSpreadthemedialparapatellarsofttissueslongitudinallywithscissors.Retractthepatellartendongentlytoallowforguide-wireinsertion.Theapproachmayalternativelyinvolvesplittingofthepatellartendon.WoundclosureBeforeclosure,irrigatewoundscopiouslywithwarmRingerlactatesolution.Closethejointcapsuleandthefasciawithabsorbablesutures.Theuseofasuctiondrainmaybeconsidered.Closetheskinmeticulouslywithnonabsorbablesutures.