Ann Surg Case Rep | Volume 7, Issue 1 | Research Article | Open Access
Pranav S1, Jinpu Li2,3, Leary E2,3 and Crist BD3*
1School of Medicine, University of Missouri, USA
2Thompson Laboratory for Regenerative Orthopedics, University of Missouri, USA
3Department of Orthopedic Surgery, University of Missouri, USA
*Correspondance to: Brett D Crist
Fulltext PDFIntroduction: Patellar fractures are potentially debilitating injuries, and surgical intervention for these injuries aims to restore knee extensor function and congruency of the articular surface while maintaining comfort. High rates of dissatisfaction with patellar fixation have led to the development of novel fixation methods, but the relative efficacies of these fixation methods compared to previous methods remain unclear. An understanding of the outcomes of patellar fixation methods will enhance clinical decision-making for patellar fixation and provide a basis from which new methods can be developed. Methods: A systematic review was conducted to identify all publications studying outcomes of different fixation methods from 1991-2021. Data from studies documenting rates of reoperation, nonunion, and complications including infection in adult patients with patellar fractures were recorded. Meta-analyses were performed on pooled proportions of union rate, complication rate, and hardware removal rate to compare the different patellar fixation methods. Results: Initially 604 studies were identified; after screening, 20 studies were included in this review and meta-analysis. Using meta-analysis methods, the union rate was 99% [95% CI 0.97-0.99] for techniques using a tension band construct while it was 100% [95% CI 0-1.0] for all other techniques. However, there was substantial heterogeneity for other operative techniques compared to the tension band construct with respect to union rates. The corresponding complication rates were 12% [95% CI 0.04-0.30] and 7% [95% CI 0.03-0.14], respectively. Specifically, hardware removal rates were calculated at 27% [95% CI 0.06-0.66] and 10% [95% CI 0.01-0.54], for tension band constructs and all other techniques, respectively, although there was significant heterogeneity. Conclusion: Tension band constructs and novel techniques for patellar fixation report similar rates of union, but novel techniques have lower complication and hardware removal rates.
Patellar fractures; Fixation; Outcomes
Pranav S, Jinpu Li, Leary E, Crist BD. A Systematic Review of Operative Fixation of Patellar Fractures and Outcomes. Ann Surg Case Rep. 2024; 7(1): 1086..