Multi-planar fixation of displaced, multi-fragmentary patella fractures in elderly patients with anterior locking plates and cerclage wires: preliminary results.

Abstract

The purpose of this study was to evaluate the outcomes of displaced, multi-fragmentary patella fractures in elderly patients treated with anterior plating and cerclage wires. Between 2018 and 2020, patients aged at least 60years old undergoing anterior plating and circumferential wiring for displaced, multi-fragmentary patella fractures with a minimum of 12months follow-up were included. Fragments were reduced and circumferentially stabilized by loop wires, followed by multi-planar fixation with an anterior locking plate and multi-directional screws. Postoperative outcomes were evaluated with the Böstman scores and range of motion. Patients were also asked about symptomatic hardware as well as satisfaction with postoperative outcomes. Sixteen patients with an average age of 71.8 ± 9.3years old were followed up for an average follow-up was 25.1 ± 8.2months. At the latest follow-up, the average Böstman scores were 27.2 ± 3.4, and active knee flexion was 123 ± 14°. Two patients complained pinpoint implant irritation and underwent implant removal. Another underwent implant removal due to cultural reasons. Fifteen patients were satisfied with the operative outcomes, and one was unsatisfied due to intermittent patellofemoral pain. Cerclage wire breakage was noted in nine patients on postoperative radiographs, but none elicited pinpoint pain. No wound complications, infections, nonunion or loss of reduction were observed. Anterior locking plates and cerclage wires in tandem provide reliable multi-planar fixation for displaced, multi-fragmentary patellar fractures in elderly patients and resulted in favorable clinical outcomes.