Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment.
BACKGROUND
The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction.


METHODS
For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall-Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated.


RESULT
This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction.


CONCLUSION
For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.
['Chang|Chih-Hsun|CH|', 'Chuang|Hao-Chun|HC|', 'Su|Wei-Ren|WR|', 'Kuan|Fa-Chuan|FC|', 'Hong|Chih-Kai|CK|', 'Hsu|Kai-Lan|KL|http://orcid.org/0000-0002-7576-2486']
D000328:Adult D001864:Bone Wires D005260:Female D005593:Fracture Fixation, Internal D050723:Fractures, Bone D006801:Humans D008297:Male D008875:Middle Aged D010329:Patella D011859:Radiography D012189:Retrospective Studies D012307:Risk Factors
Inferior pole Tension band wire Transosseous reattachment Patellar fracture