Suturing and wiring a novel technique for Osteosynthesis of inferior pole patella fracture: A prospective comparative study

Abstract

Background: Osteosynthesis and partial patellectomy with patellar tendon repair are accepted procedures for inferior pole fracture of patella. Fractures of lower end of patella are usually avulsion injuries due to forceful flexion of knee against contracted quadriceps muscle. Multiple small fragments attached to patellar tendon make the management difficult. We conducted a prospective study of clinical and radiological outcome of inferior pole of patellar fractures treated with patellar tendon repair with non absorbable Ethibond and circumferential wiring. We compared the results with those of mid patellar fractures treated with modified tension band wiring technique. Materials: We included all patients with lower pole patella fractures, presented to our department from 2012 to 2015. We included patients with fracture 34 A1 (b) (extra articular lower pole) and 34C1.3 (complete articular distal 3rd fracture). These fractures were fixed with Ethibond 5 by making transosseous longitudinal drill holes and supplemented with circumferential stainless steel wires. Bostman scoring system was used to analyze and assess clinical results. We compared the results with midpatellar fractures treated by tension band wiring at the end of follow up period. Results: We recruited 21 patients with inferior pole patella fractures. Independent T Test was used to compare the means of Bostman scoring, flexion and loss of extension of knee joint between two groups of patients. Anterior knee pain and implant loosening was found more prevalent in midpatellar fracture treated by tension band wiring technique and required implant removal. There was no significant difference between two groups of patients. Conclusion: Lower pole patella fracture can be successfully treated by this novel technique of fixation with less number of complications. Comminuted lower pole fractures which otherwise needed excision may be preserved with this technique.