A Novel Technique for Supplementing Transosseous Suture Repair of Inferior Pole Patella Fractures with a Tension Band.

Abstract

The transosseous suture fixation is a recognised surgical technique for inferior pole patella fractures. However, post-operative range of motion (ROM) is typically restricted to reduce complications of fracture displacement. We present a novel modified surgical technique using a supplemental Ethibond figure-of-eight stitch to reinforce the transosseous suture repair and studied its outcomes. We performed a retrospective study looking at outcomes of patients with displaced inferior pole patella fractures who underwent modified suture fixation from 2010 to 2018. In the modified suture fixation technique, after the standard transosseous repair was performed, the remnant Ethibond suture was placed in a figure-of-eight tension band fashion anteriorly across the patella. Immediate post-operative ROM was allowed if the fixation was stable. The patients were assessed up to 6 months post-surgery to monitor for fracture displacement/gap and for bony union. We analysed the results of 14 patients who underwent modified suture repair. All patients were allowed immediate post-operative ROM. Only 1 fixation failure (7%) was noted at 6 months. Complication rates were low with the modified technique even when patients were allowed immediate post-operative mobilisation. This shows greater confidence in the stability of the fixation and represents a viable technique for early mobilisation post-fixation of inferior pole patella fractures.