Open reduction and internal fixation of comminuted patellar fractures with headless compression screws and wiring technique.

Abstract

Management of a displaced comminuted patellar fractures is challenging, and various surgical fixation methods have been suggested. However, issues of loss of reduction and breakage of fixatives have not yet been resolved. In the current study, we describe a new technique for exposure and stabilization of comminuted patellar fractures and evaluate the clinical and radiologic outcomes of this new treatment. Thirteen patellar fractures with articular comminution, which were treated by headless compression screws with additional separate vertical wiring were enrolled in this study. Loose articular fragments were fixed with headless compression screws under direct visual reduction of the articular surface, which was facilitated by the superior everting of the patella. Radiographs of the knee were obtained at routine follow-up to assess fracture healing and widening of articular step-off. Clinical outcomes including range of motion, quadriceps circumference, visual analog scale (VAS) related pain score, Lysholm, and Bostman grading scales were measured at the last follow-up. All the fractures healed at a mean of 15 weeks. No patient had loss of reduction, evidence of implant migration, or metallic failure. Articular step-off larger than 2mm was not seen in any of the cases. The average range of motion arc was 134.2° (range, 120°-145°), and the mean Lysholm and Bostman scores were 94.4 (range, 84-100 points) and 28.7 (range, 25-30 points), respectively. Thigh muscle wasting was observed in four patients (33.3%), but no patient had >1.5cm difference in thigh circumference girth between the injured and uninjured lower limbs. The average VAS-related pain score was 0.4. Articular fixations with headless compression screws under direct visual reduction of the articular surface resulted in good clinical outcomes and were considered clinically effective for comminuted patellar fractures.