Clinical outcomes of contoured dorsal mini-fragment plate fixation versus tension band wiring for transverse articular patellar fractures: a prospective observational study.

Abstract

Articular patellar fractures (AO/OTA 34-C1/C2) are commonly treated with internal fixation. This non-randomized prospective observational study aimed to compare clinical and functional outcomes between two osteosynthesis techniques: contoured dorsal mini-fragment plate and tension band wiring. All patients who underwent surgical fixation for transverse articular patellar fractures between November 2023 and January 2025 were prospectively enrolled. Patients were divided into two groups: Group A, treated with a dorsal mini-fragment plate, and Group B, treated with tension band wiring. Demographic data, failure rate, hardware removal rate, and range of motion (ROM) at 1 year postoperatively were compared between groups. In addition, functional outcomes and quality of life were assessed at a minimum follow-up of 1 year using the Kujala Anterior Knee Pain Scale (AKPS) and the 12-Item Short Form Health Survey (SF-12). A total of 54 patients were included (Group A: n = 24; Group B: n = 30). Compared with Group B, Group A showed a lower failure rate (8.3% vs. 16.7%, p = 0.44; OR 0.45) and a lower rate of hardware removal (4.5% vs. 24.0%, p = 0.11; OR 0.15), although these differences did not reach statistical significance. Functional outcomes were significantly better in Group A, with a greater median postoperative range of motion (105° vs. 100°, p = 0.011) and higher median Kujala scores (84 vs. 75, p = 0.005). Median SF-12 Physical Component Summary (PCS) scores were significantly higher in Group A (45.56 vs. 42.73, p = 0.016), whereas median Mental Component Summary (MCS) scores were comparable between groups (56.56 vs. 56.30, p = 0.788). Contoured dorsal mini-fragment plate fixation may be associated with better functional outcomes at 1-year follow-up than tension band wiring. Lower implant failure and hardware removal rates were observed, although these differences were not statistically significant. Given the observational design, these findings should be considered hypothesis-generating.