Anterior Locking Plate Osteosynthesis of Patellar Factures – Analysis of Complications and Functional Outcome

Abstract

Background Tension band wiring is the standard procedure for patellar fractures, but is associated with a high rate of implant related complications and implant failure. Tension band wiring may fail, especially with multifragmentary and comminuted fractures. Plate fixation of complex patellar fractures seems to be superior to wiring, both clinically and biomechanically. The aim of this study was to evaluate complications after locking plate fixation in patellar fractures two years after surgery and to access the functional outcome. Material and Methods As part of a prospective case series, all patients who had received locking plate fixation of a patellar fracture between April 2013 and May 2018 were clinically examined two years postoperatively and potential complications were evaluated. Results A total of 38 patients aged 19 – 87 years were included. Complications occurred in a total of five patients (13%), including one reactive prepatellar bursitis, one chronic infection and loss of reduction due to a dislocated pole fragment in three cases. The average active range of motion of the affected knee joint two years postoperatively was 133°. The Tegner activity scale score reached 3 points, the Lysholm score 95 points and the Kujala score 95 points. Conclusion With an overall relatively low complication rate and good clinical outcome, dislocated distal pole fragments are a common complication after plate fixation of patellar fractures. If preoperative diagnostic testing shows a pole fragment, a modified hook-plate can be used, with the possibility of fixing the pole fragment.

Modified Tension Band Wiring Using Only Non-Absorbable Braided Polyblend Sutures for the Treatment of Patellar Fractures

“…Although, the comminuted fractures and those of the inferior pole of the patella have limited therapeutic options, including partial patellectomy and locking plates, a tension banding technique should also be used to preserve the extensor mechanism [2,3,12]. Although the introduction of anterior locking plates, either alone or in combination with metal cerclages, was associated with promising outcomes, their use is not risk free in terms of soft tissue complications (up to 13%) [17][18][19].…”

Patellafrakturen

“…Zudem kann eine Polbeteiligung bei mehrfragmentärer Frakturform nativradiologisch leicht übersehen werden. In einer aktuellen Arbeit von Tengler et al wird eine Polbeteiligung bei 88% der 41 untersuchten Patienten beschrieben, die in 50% der Fälle nativradiologisch vorher nicht erkannt wurde 18 . In solchen Fällen ist eine CT-Untersuchung mit multiplaneren Rekonstruktionen für die präoperative Planung angezeigt.…”

“…Trotz winkelstabiler Plattenosteosynthese sind sekundäre Polausrisse auch bei einliegender Hakenplatte beschrieben und auch in der eigenen Anwendung dokumentiert 18 . Hier ist besonders eine vorbestehende, signifikante Osteoporose und Fragmentierung des Polfragments zu beachten.…”

“…In der eigenen Anwendung wird die winkelstabile Plattenosteosynthese zunehmend eingesetzt. Die bisherigen Ergebnisse sind bei niedriger Komplikationsrate äußerst vielversprechend [16,18]. Nach einer aktuellen Umfrage unter über 500 Mitgliedern der DGOU und der DKG werden Mehrfragmentfrakturen in 40 % der Fälle noch mittels Zuggurtung und in bereits 30 % mittels Plattenosteosynthese versorgt [10].…”

Plate Osteosynthesis

“…[20] Complication rates of 13% (5 out of 38 cases) in a series were noted like reactive prepatellar bursitis, chronic infection, and loss of reduction on account of pole fragment dislocations in three cases. [21] Mesh plating for intra-articular fractures and a mini-plate shaped like a basket (basket plate) for inferior pole fractures is also used and as per the recent systematic review, plating records better clinical outcome, fewer complications, and high union rates as compared to TBW. [22]…”