Implant Removal Following Surgical Stabilization of Patella Fracture

Abstract

Patella fractures are relatively common injuries. Tension band wiring is commonly used to treat displaced patella fractures. The goal of this study was to assess the outcome and implant removal rate following surgical stabilization of patella fracture. A consecutive series of 67 patients over a 6-year period was reviewed. Minimum follow-up to fracture healing (3 months) was available in 63 patients. Forty-three men and 24 women with a mean age of 49 years (range, 14-90 years) underwent surgical stabilization of patella fracture. Three open fractures and associated injuries were noted in 22 patients. Surgical treatment methods used were: tension band wiring in 44, tension band wiring with cerclage wire in 13, tension band wiring with screws in 4, and screw fixation in 6. All fractures united. Two superficial infections responded to oral antibiotics. One patient had revision surgery at 6 weeks. Twenty-two patients required implant removal for implant-related symptoms. Mean follow-up in asymptomatic patients was 8 months (range, 3-18 months) and in patients with implant-related problems was 17 months (range, 10-36 months). Four patients were lost to follow-up. Surgical stabilization of patella fractures by current techniques demonstrated satisfactory fracture union. However, 1 in 3 required surgery for implant-related symptoms. In the younger than 60 years group, the implant removal rate was 40%. This high rate of implant removal must be discussed with the patient prior to surgery. Newer techniques to avoid skin irritation should be considered.

Non-metallic fixation of patella fractures using high resistance suture materials

“…The studies gave good functional outcomes, but the rate of implant removal was still on a higher side. [21] Gosal et al, performed a study comparing two groups for patella fracture fixation, one metallic group and the other a non-metallic group and concluded that the metallic group had higher infection and morbidity rates when compared to the non-metallic group and hence the study supported the use of non-metallic implants for patella fractures [22] . Limitations of the study that must be taken into account are this study is a single-center study with a relatively small sample of patients.…”

Non-metallic implant for patellar fracture fixation: A systematic review

“…Further, single and multiple cannulated screws have been proposed for fixation of patellar fracture instead of tension-band wiring technique. Even good rates of success have been reported using pre-mentioning fixation technique, a high rate of second re-operation for implant removal has been detailed [2][3][4][5]. For this reason, different authors have advocated the use of non-metallic implant for fixation of patellar fractures such as bioabsorbable screws and non-absorbable sutures [6][7][8][9].…”

Patella fractures in adults

“…[19] Cerrahi olarak tedavi edilen patella kırıklarının yaklaşık %40'ında implant çıkarma amacıyla ikinci bir cerrahiye gereksinim vardır. [20] Cilt altındaki tellerin potansiyel tahrişi nedeniyle son yıllarda anteriyor gergi bandı tespitinde 5 numara örgülü polyester (Ethibond) dikiş veya biyobozunur materyal ile tespit gündeme gelmiştir. Yapılan iki çalışmada hem dikişin hem de biyobozunur materyallerin başarıyla kullanı-mı belirtilmiştir.…”