Excellent Results with Low Reoperation Rates After Fixation of Patella Fractures with a New Anatomically Contoured Plating System.

Abstract

To assess the clinical and radiographic outcomes of a consecutive series of patellar fractures treated utilizing an anatomically contoured variable-angle patellar plating system (PPS) (Synthes; Paoli, PA). Design: Retrospective chart review. Single, academic, Level-1 Trauma center. All adult patients who underwent fixation of a patellar fracture (AO/OTA 34) with the PPS between 2021 and 2024 with a minimum follow-up of 3 months. Post-operatively, full extension was maintained for six weeks. The primary outcome was fixation failure. Secondary outcomes included range of motion (ROM) at final follow-up, knee pain due to symptomatic implants, infection, and reoperation. Deep infection was defined as a return to the operating room for irrigation and debridement. There was a total of 61 patients with a mean age of 54 years (19-92 years). The cohort consisted of 32 females (52%) with a mean BMI of 27 kg/m2 (18-42 kg/m2). Fifteen patients (25%) had diabetes and 16 patients were smokers (26%). The average follow-up was 7 months (range 3 - 26 months).There were 2 34A1 fractures, 1 34B1 fracture, 16 34C1 fractures, 10 34C2 fractures, and 32 34C3 fractures. There were 6 open fractures (1%), 2 type II and 4 type IIIA.There were 54 (89%) patients who achieved uneventful healing. Seven patients (11%) experienced a postoperative complication. One patient developed a superficial wound infection which resolved with oral antibiotic therapy, 3 patients developed arthrofibrosis necessitating further intervention, 2 patients experienced fixation failure with one requiring revision fixation, and 1 patient developed osteomyelitis and underwent implant removal after fracture union. Of the 3 patients with arthrofibrosis one underwent manipulation under anesthesia, and two underwent arthroscopic lysis of adhesions. The PPS may be utilized to stabilize challenging patellar fractures, leading to reliable union and minimal implant-related complications when associated with a post-operative protocol of full extension maintained for six weeks. Level IV.