Excellent Results with Low Reoperation Rates After Fixation of Patella Fractures with a New Anatomically Contoured Plating System.

Abstract

Objectives: To assess the clinical and radiographic outcomes of a consecutive series of patellar fractures treated utilizing an anatomically contoured variable-angle patellar plating system (PPS) (Synthes; Paoli, PA).

Methods: Design: Retrospective chart review.

Setting: Single, academic, Level-1 Trauma center.

Patient selection criteria: All adult patients who underwent fixation of a patellar fracture (AO/OTA 34) with the PPS between 2021 and 2024 with a minimum follow-up of 3 months. Post-operatively, full extension was maintained for six weeks.

Outcome measures and comparisons: The primary outcome was fixation failure. Secondary outcomes included range of motion (ROM) at final follow-up, knee pain due to symptomatic implants, infection, and reoperation. Deep infection was defined as a return to the operating room for irrigation and debridement.

Results: There was a total of 61 patients with a mean age of 54 years (19-92 years). The cohort consisted of 32 females (52%) with a mean BMI of 27 kg/m2 (18-42 kg/m2). Fifteen patients (25%) had diabetes and 16 patients were smokers (26%). The average follow-up was 7 months (range 3 - 26 months).There were 2 34A1 fractures, 1 34B1 fracture, 16 34C1 fractures, 10 34C2 fractures, and 32 34C3 fractures. There were 6 open fractures (1%), 2 type II and 4 type IIIA.There were 54 (89%) patients who achieved uneventful healing. Seven patients (11%) experienced a postoperative complication. One patient developed a superficial wound infection which resolved with oral antibiotic therapy, 3 patients developed arthrofibrosis necessitating further intervention, 2 patients experienced fixation failure with one requiring revision fixation, and 1 patient developed osteomyelitis and underwent implant removal after fracture union. Of the 3 patients with arthrofibrosis one underwent manipulation under anesthesia, and two underwent arthroscopic lysis of adhesions.

Conclusions: The PPS may be utilized to stabilize challenging patellar fractures, leading to reliable union and minimal implant-related complications when associated with a post-operative protocol of full extension maintained for six weeks.

Level of evidence: Level IV.