Outcome of Inferior Patellar Pole Avulsion Fractures

Abstract

Introduction: The optimal treatment for inferior pole patella avulsion fractures has still been a topic of debate. The options include (a) internal fixation of the pole fragment and (b) resection of the avulsed fragment and repair of the patellar ligament to the patella. We present the comparative outcomes for patients with displaced inferior pole patella treated by resection and transosseous Ethibond® Krackow suture repair of patellar ligament with open reduction and internal fixation with modified tension band wiring and circumferential wiring.
 
 Methods: During a three year period between August 2013 and September 2016, twenty consecutive patients with distal pole fractures of the patella were prospectively enrolled in this study. These patients were divided into two groups. Group-T patients were treated with open reduction and internal fixation with modified tension band wire and group-R patients by resection of the avulsed fragment and reattachment of the patellar ligament to the patella with #5 Ethibond®. Data entry and analysis was done by using SPSS version 20. Anatomical and functional outcome were compared.
 
 Results: Consecutive 20 patients were treated either with resection lower patellar pole (n=10) or with open reduction internal fixation with tension band wiring (n=10). Demographics were matched in two groups. Group-T required a longer hospital stay (U=13.5, p=0.005). Complications were seen more often in Goup-T compared to Group-R (p=0.005). Group-R had better scores (Bostman score U=6, p=0.001; SFMA U=7.5, p=0.001) and range of movement (p<0.05).
 
 Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had better outcome according to the Bostman and SFMA dysfunction score, shorter hospital stay, and less complications as compared to open reduction and internal fixation with tension band wire and circumferential wiring.

Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study

“… 5 , 12 , 16 – 18 A common technique is partial patellectomy and patellar tendon reattachment using transosseous tunnel (TT), with data demonstrating superior patient-reported outcomes and fewer hardware-related complications when compared with tension band wiring. 8 …”

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

“…There is a reoperation rate between 20% and 50% when inferior pole fractures are fixed with K-wires. [11] Even wiring and screw fixation do not offer any rigid fixation due to inherent weakness of bone and loose fragments when it is comminuted as in our study. In addition reported by Chang et al, fixation usually fails and various metal implants are not able to hold before failure.…”

Lower pole of patella fractures treated with non-absorbable trans-osseous sutures: an effective surgical method to avoid implant related complications

“…There is a re-operation rate between 20% and 50% when inferior pole fractures are fixed with K-wires. 7 In many of these reoperated knees, restriction of knee joint range of motion developed. The number of implants related metallic complications were very high in these patients as there was a high incidence of K-wire migration and the stainlesssteel wire knots that were not buried properly produced skin irritation, ulcers and infections.…”

“…Because of this, treating this type of fracture poses a special problem. 6,7 There are various previously defined surgical fixation options for patella inferior pole fractures: anterior tension band wiring, combining screw fixation with tension band, patellotibial cerclage, fixed angle plate application,…”