Current Practices and Outcomes of Patella Fracture Fixation

Purpose Patella fractures account for approximately 1% of all fractures. Standard treatment includes nonoperative management, screw fixation, anterior tension band wiring, partial patellectomy, and plate osteosynthesis. The choice of surgical treatment is dependent on a multitude of factors, including fracture type, degree of displacement, age and expected activity, and more. Treatment of patella fractures with hardware can result in undesirable outcomes, including residual knee pain, stiffness, re-displacement or re-injury, and even hardware failure. Anterior plating of patellar fractures is a newer, promising treatment modality, reserved primarily for multifragmentation and severe displacement. This review aims to provide insight into outcomes and best practices regarding currently utilized surgical techniques for patella fractures. Methods A systematic search for articles was conducted in the PubMed database. Article types included were prospective cohort studies, retrospective reviews, and biomechanical studies, all from peer-reviewed journals. Studies conducted within the past decade (2012-2022) that analyzed fixation of various patella fracture patterns were included. Treatments of focus included standard screw fixation, tension band wiring, tension band wiring with augmentation, and various plating techniques. Fracture patterns ranged from simple transverse to complex comminuted patella fractures. Results Twenty-three studies (11 biomechanical, 8 prospective, and 4 retrospective) were included in the review, investigating a combined 394 individual patella fractures. The transverse patellar fracture was the most common fracture pattern treated and analyzed (10 articles) included in the review. Common outcomes analyzed included knee range of motion, activities of daily living, knee pain, and various standardized knee and patella scoring systems, such as the Modified Cincinnati knee rating system or the Kujala score. Conclusions Tension band wiring continues to remain a safe and proven technique for various fracture types of the patella. Plating constructs, as a newer modality, show promising results when compared to other standard methods in patella fracture fixation, including superior clinical outcomes, lower non-union rates, and fewer complications. Limitations of some plating techniques include lack of long-term data, especially the newer models, and increased associated costs. Biomechanical comparison between various anterior plates is limited and warrants further investigation.