# Influence of Weight-Bearing Status After Tension Band Wiring of Patellar Fractures in Elderly Patients

## TL;DR

This study finds that elderly patients with patellar fractures can benefit from starting to bear weight immediately after surgery, leading to faster healing and better knee function.

## Contribution

The study provides evidence that immediate weight-bearing after tension band wiring improves outcomes in elderly patients with patellar fractures.

## Key findings

- Immediate weight-bearing resulted in faster fracture union and greater knee range of motion.
- Immediate weight-bearing reduced loss of reduction and allowed earlier initiation of knee flexion.
- No significant differences were found in implant failure or need for reoperation between groups.

## Abstract

Background

Patellar fractures can severely affect mobility in the elderly, particularly due to compromised bone quality. Tension band wiring (TBW) is commonly used to repair displaced transverse fractures and permits early mobilization; however, the optimal timing for weight-bearing in elderly patients has not been clearly established. This study evaluated the outcomes of immediate versus delayed weight-bearing following TBW.

Methods

A retrospective cohort study was conducted involving elderly patients (≥60 years) from two hospitals in London. Patients were categorized into immediate (Day 0 post-op, n = 14) and delayed (>Day 0 post-op, n = 10) weight-bearing groups. Primary outcomes included knee range of motion (ROM), degree of extensor lag, reoperation rate, and time to union. Secondary outcomes included loss of fixation, implant failure, time to initiate knee flexion, and adherence to the rehabilitation protocol.

Results

Overall, patients in the immediate weight-bearing (IWB) group achieved union faster (8.4 weeks versus 13.7 weeks; p = 0.01), experienced less loss of reduction (n = 0, 0% versus n = 3, 30%; p = 0.03), had greater knee ROM (120.5° versus 101.3°; p = 0.02), and initiated knee flexion sooner (6.0 weeks versus 7.2 weeks; p < 0.001). There were no statistically significant differences between groups in extensor lag, need for reoperation, implant failure, or adherence to rehabilitation.

Conclusions

IWB after TBW of patellar fractures in elderly patients promotes fracture healing, knee function, and stability compared to traditional non-weight-bearing protocols and does not increase complication rates, supporting early mobilization strategies. Multicenter prospective studies with standardized fracture patterns are required to confirm these findings.