Patellar Fracture Fixation Techniques and Outcomes

Patellar fractures, although relatively uncommon, pose significant challenges due to the patella’s key role in knee extension and load transmission. Stable fixation that restores articular congruity and permits early mobilisation is essential to avoid stiffness, extensor lag and post-traumatic osteoarthritis. Traditional open techniques, notably tension-band wiring with Kirschner wires, remain prevalent but are frequently complicated by hardware irritation and secondary implant removal. To address these limitations, novel approaches such as cannulated screws with anterior tension bands, high-strength suture augmentation and percutaneous fixation have been developed. Finite element modelling has informed optimal implant positioning and construct design, enhancing compressive forces at the fracture interface. Clinical studies demonstrate that these evolving techniques can yield improved pain control, superior functional scores and accelerated return to activity, while reducing non-union, loss of reduction and hardware-related complications.

Research from Nature Portfolio

A recent clinical evaluation of rim-plate-augmented separate vertical wiring with supplementary fixation for comminuted inferior pole patellar fractures reported bony union in all cases at an average of 3.1 months. No instances of reduction loss, fixation failure or deep infection were observed. Functional testing revealed an average final knee flexion of 131.6° and steadily improving Lysholm scores over a one-year follow-up, while isokinetic measurements demonstrated marked recovery of quadriceps torque. This technique provides robust stabilisation of complex inferior pole patterns, facilitating early rehabilitation and minimising postoperative complications.

Patellar Fracture Fixation Techniques and Outcomes publication trend

The graph below shows the total number of articles in patellar fracture fixation techniques and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Tension-band wiring: a fixation method in which wires looped in a figure-of-eight transform tensile forces on the patella’s anterior surface into compressive forces at the fracture site.

Cannulated screw: a hollow, threaded implant inserted over a guide wire to achieve interfragmentary compression with minimal soft-tissue disruption.

Finite element analysis: a computational modelling technique that predicts the mechanical behaviour of bone-implant constructs under simulated physiological loads.

Open reduction and internal fixation (ORIF): a surgical approach involving direct exposure of the fracture, anatomical realignment and stabilisation with internal hardware.

Bostman score: a validated clinical scoring system evaluating pain, function, range of motion and complications following patellar fracture repair.

References

1. Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study. Frontiers in Bioengineering and Biotechnology (2024).
2. Clinical outcome of rim-plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole. Scientific Reports (2023).
3. High return to sports rates after operative treatment of patella fractures. European Journal of Medical Research (2023).
4. Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation. BMC Musculoskeletal Disorders (2019).