Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection

Abstract

In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by preserving the patellar pole. In contrast with pole resection, which requires postoperative immobilization, internal fixation with a basket plate allows for immediate mobilization and early weight-bearing. The present study indicates that internal fixation with use of a basket plate can provide better clinical results.

Role of suture anchors in management of fractures of inferior pole of patella

“…Veselko et al ,4 have reported good long term results with basket plate osteosynthesis versus patellar ligament repair for inferior pole avulsion patellar fractures. Patellar height is preserved at long term follow-up and mobilization is much faster as contrast with ligament repair.…”

“…The traditional recommendation for displaced comminuted inferior pole fractures is excision of the comminuted pole followed by reattachment of the patellar tendon with transosseous suture. There has been one published study on better outcomes obtained following use of a basket plate to attach the avulsed inferior pole of patella as compared to resection of inferior pole of patella4. To the best of our knowledge there has been no previous published study mentioning the use of suture anchors for fractures of the inferior pole of patella.…”

Management of comminuted extraarticular inferior pole patella fractures with partial patellectomy and patellar tendon repair by transosseous sutures

“…[5] Iqbal et al [15] in their comparative study found that reattachment of patella tendon to patella showed better clinical results than open reduction and fixation with tension band wiring and our study results were at par with theirs. Veselko and Kastelec [16] in their study found that basket plate fixation gave better outcome compared to partial patellectomy in the management of comminuted inferior pole patella fractures by retaining inferior pole and earlier mobilization. Basket plate is still not in regular use, not available in India and not an economical option for a country of low socioeconomic status.…”

Patellar Fractures

“…2 Fractures among the inferior pole have an added problem, the difficulty of surgical repair due to the small amount of bone tissue available or the comminution of the fracture. 3 Once surgery is performed, these types of fractures present with two battlefields for the orthopedic surgeon.…”

“…Surgical steel, wire, are the most frequent materials used in most centers, due to their ease of use and access. [2][3][4][5] One step for the improvement of this critical point is the use of more resistant materials such as a titaniummade plate or even high-resistant sutures that avoid the removal. With all these variants, we will be able to observe better indexes of fracture consolidation, and fewer local complications and removal of material.…”