Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish Fracture Register

Abstract

Background Basic epidemiological data on patella fractures derived from large nationwide and multicenter studies are scarce. This observational register study describes patient epidemiology, fracture classification and treatment of patella fractures in adults in a Swedish population. Methods We conducted an observational study on data derived from the Swedish Fracture Register (SFR) on all patella fractures classified as non-periprosthetic and non-pathological, registered between 2014 and 2018 in individuals aged ≥ 18years. Epidemiological data on sex, age, side, seasonal variation, trauma mechanism, fracture classification (according to AO/OTA), and treatment were analyzed. Results 3194 patella fractures were analyzed, occurring at a median age of 67 (range 19–100) years. 64% of all patients were female. Most fractures were caused by low-energy trauma, with 70% due to falling from a standing height. 1796 (56%) of the fractures were transverse compared to 845 (26%) vertical fractures. Most fractures (N=2148, 67%) were treated non-operatively. Operative treatment consisted mainly of Tension Band Wiring (TBW) performed in 774 (24%) patients. Conclusions Patella fractures mainly occur in elderly women (> 65 years), commonly caused by low-energy trauma. The main treatment is non-operative (67%), except for transverse (AO/OTA C3) fractures. TBW remains the most used operative treatment of choice. These results may help health care providers, researchers and clinicians better understand the panorama of patella fractures in Sweden.

Developments in the epidemiology and surgical management of patella fractures in Germany

“…No further classifications or subtypes are sampled. Again, comparing this data to the Swedish Registry Data, approximately 64% complex fractures were found in our study compared to 72% for Sweden [ 26 ]. This demonstrates that the underreporting of simple fractures does not appear to occur in our study.…”

“…The annual ratio of conservative versus surgical treatment has never been reported until now in a study using epidemiological data. The Swedish Fracture Registry recently reported about 3194 patella fractures occurring over a 5-year period [ 26 ]. In this cohort, 2138 (66.9%) of cases were treated conservatively.…”

“…Another potential explanation for an increase in complexity of fractures may be due to a change in the frequency of injury causes. High energy trauma like those suffered when involved in a road traffic accident is such a potential cause as traffic accidents have previously been reported as one of the leading causes of traumatic patella fractures and are more commonly high energy in nature than simple falls, the most common cause for patella fractures [ 6 , 26 , 29 ]. To evaluate a possible connection, we used the data on traffic accidents collected by the federal department of the interior on the frequency of road traffic accidents in Germany.…”

Nonmetallic tension band fixation is a viable and low-complication surgical technique in patellar fractures: a five-year retrospective study

“…Patellar fractures (PFs), which account for about one percent of all skeletal fractures, are generally caused by low-energy trauma and are more common in women older than 65 years [ 1 – 3 ]. Until the nineteenth century, PFs were treated with splints in extension [ 4 ]; since around the 1950s, Muller et al introduced the anterior tension band technique for the surgical treatment of these fractures [ 5 ].…”

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study

“…There are many surgical options for TPFs, with tension-band wire with K-wire (TBW) being the most widely used ( Kruse et al, 2022 ). The tension band technique converts the patellar surface tension generated by the extensor muscle during knee flexion into the axial compression force of the patellar fracture surface, thereby promoting bone healing and demonstrating good efficacy ( Jia et al, 2022 ).…”