Surgical Outcomes Following Patella Fracture Repair: A Single-Center Retrospective Cohort Study

TL;DR

This study examines surgical outcomes for patella fractures over 15 years, finding high complication rates and variable recovery times based on surgical techniques.

Contribution

The study provides a detailed analysis of surgical outcomes and complications in patella fracture repair at a single center over a long period.

Findings

Tension band wiring was the most common surgical technique but had a high rate of hardware irritation.

Recovery times varied significantly depending on the surgical method used.

Conservative management resulted in the shortest recovery time compared to surgical interventions.

Abstract

Introduction

Patella fractures are an uncommon yet complex injury, accounting for approximately 1% of presentations to orthopedic departments. Surgical management is indicated for unstable, displaced, or comminuted fracture patterns, with the aim of restoring the extensor mechanism and preserving knee function. Various surgical techniques are available, each with differing complication profiles. This study evaluated surgical outcomes following patella fractures over a 15-year period within a single-center orthopedic department.

Methods

A retrospective cohort study was conducted. A single-center trauma and orthopedic database was reviewed over a 15-year period from 2008 to 2023. Inclusion criteria comprised patients presenting with patella fractures. Exclusion criteria included patients transferred to another healthcare provider for management, those lost to follow-up, or patients who did not engage with planned follow-up. Data analyzed included fracture morphology, time to surgery, surgical technique, complications, reoperation rates, and recovery duration. All patients followed a standardized physiotherapy protocol.

Results

A total of 100 patella fractures were included, of which 65/100 (65%) underwent surgical fixation. The mean age of patients requiring operative management was 60 years (range: 17-95), and 64.6% were female. The most prevalent fracture morphologies were transverse (44.6%) and comminuted (38.4%). The most commonly used surgical technique was tension band wiring (TBW, 64.6%), followed by cerclage wiring, partial excision with tendon repair, and cannulated screws. Across all surgical patients, the average time to recovery was 7.4 months. TBW had a mean recovery duration of 6.8 months. The shortest recovery times were observed for open reduction and internal fixation with screws (3.25 months), and the longest with excision of distal bone (24 months). Patients managed conservatively had the shortest recovery time at 2.7 months. Postoperative complications occurred in 44.6% of surgical patients. The leading complication was metalwork irritation (24.6%), which led to reoperation in 13/65 patients. Other complications included malunion, stiffness, wound infection, and non-union. There was no significant difference in recovery time between patients operated on within one day versus later.

Conclusions

Surgical management of patella fractures is associated with good functional outcomes; however, this study found a high rate of postoperative complications and subsequent reoperations. The most predominant reason was hardware irritation associated with TBW. These findings highlight the need for careful planning and individualization based on fracture morphology and patient factors. Recovery time is influenced by the fixation method, and current evidence on optimal postoperative recovery expectations is limited. These results underscore the need for further research to guide surgical decision-making and rehabilitation protocols.

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