Journal of orthopaedic trauma · 2026
Initial Patella Vertical Fracture Displacement Is a Predictor of Nonunion and Hardware Failure.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Lashgari Alexander M, Goldstein Amelia R, Monroe George W, Ganta Abhishek, Konda Sanjit, Egol Kenneth A
Аннотация
OBJECTIVES: To determine if initial vertical fracture displacement affects postoperative outcomes after operative treatment of patella fractures.
DESIGN: Prognostic retrospective study.
SETTING: Single multisite urban academic institution.
PATIENT SELECTION CRITERIA: Included were patients aged ≥18 years who underwent open reduction internal fixation of a patella fracture (AO/OTA 34A-C) with minimum 6-month follow-up and complete trauma knee x-ray series. Vertical fractures and those without significant vertical displacement (<2 mm) were excluded.
OUTCOME MEASURES AND COMPARISONS: Initial vertical fracture displacement was recorded. Follow-up data included knee range-of-motion and postoperative complications: nonunion, fracture-related infection, hardware failure, suspected fracture-related infection, knee contracture, inferior sleeve displacement, and venous thromboembolism events. Comparisons were made between the initial amount of displacement and postoperative complications.
RESULTS: Two hundred twenty-nine patients with a median follow-up duration of 12 months (Interquartile range: 6-14) were included. The mean age was 61.2 ± 15.1 years, body mass index was 25.4 ± 4.7 kg/m 2 , and 69.0% (n = 158) were female. Orthopaedic Trauma Association fracture classification was 35.4% C1, 32.3% C3, 17.9% C2, and 14.4% A1. Fixation methods included 63.8% tension band wiring, 17.9% suture repair, 13.5% plate and screws, and 4.8% screws with suture. Thirty-three (14.4%) patients sustained complications. The mean displacement was significantly higher in patients who developed complications (21.6 mm ± 15.0 mm vs. 14.8 mm ± 10.1 mm, P = 0.018), particularly for nonunion (29.8 mm ± 13.5 mm vs. 15.1 mm ± 10.6 mm, P < 0.001) and hardware failure (30.8 mm ± 12.0 mm vs. 15.4 mm ± 10.9 mm, P < 0.001). Suture-only and screw-with-suture fixation had higher nonunion rates ( P = 0.004, P = 0.005) than other fixation methods independent of displacement. Initial displacement predicted nonunion and hardware failure (AUROCs = 0.818 and 0.838). Youden Index thresholds of >26.6 mm and >21.7 mm identified patients at increased risk for nonunion and hardware failure. Each millimeter increase in displacement raised nonunion and hardware failure risk by 14.9% (OR = 1.1, P = 0.003) and 14.6% (OR = 1.1, P = 0.003).
CONCLUSIONS: This study supports the future use of initial vertical fracture displacement as a prognostic tool for nonunion and hardware failure after patella open reduction internal fixation. Displacement >2 cm placed patients at high risk for these complications. Nonunion rates were higher in both suture-only and screw-with-suture fixation when compared with other fixation constructs.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Prognostic retrospective study.
SETTING: Single multisite urban academic institution.
PATIENT SELECTION CRITERIA: Included were patients aged ≥18 years who underwent open reduction internal fixation of a patella fracture (AO/OTA 34A-C) with minimum 6-month follow-up and complete trauma knee x-ray series. Vertical fractures and those without significant vertical displacement (<2 mm) were excluded.
OUTCOME MEASURES AND COMPARISONS: Initial vertical fracture displacement was recorded. Follow-up data included knee range-of-motion and postoperative complications: nonunion, fracture-related infection, hardware failure, suspected fracture-related infection, knee contracture, inferior sleeve displacement, and venous thromboembolism events. Comparisons were made between the initial amount of displacement and postoperative complications.
RESULTS: Two hundred twenty-nine patients with a median follow-up duration of 12 months (Interquartile range: 6-14) were included. The mean age was 61.2 ± 15.1 years, body mass index was 25.4 ± 4.7 kg/m 2 , and 69.0% (n = 158) were female. Orthopaedic Trauma Association fracture classification was 35.4% C1, 32.3% C3, 17.9% C2, and 14.4% A1. Fixation methods included 63.8% tension band wiring, 17.9% suture repair, 13.5% plate and screws, and 4.8% screws with suture. Thirty-three (14.4%) patients sustained complications. The mean displacement was significantly higher in patients who developed complications (21.6 mm ± 15.0 mm vs. 14.8 mm ± 10.1 mm, P = 0.018), particularly for nonunion (29.8 mm ± 13.5 mm vs. 15.1 mm ± 10.6 mm, P < 0.001) and hardware failure (30.8 mm ± 12.0 mm vs. 15.4 mm ± 10.9 mm, P < 0.001). Suture-only and screw-with-suture fixation had higher nonunion rates ( P = 0.004, P = 0.005) than other fixation methods independent of displacement. Initial displacement predicted nonunion and hardware failure (AUROCs = 0.818 and 0.838). Youden Index thresholds of >26.6 mm and >21.7 mm identified patients at increased risk for nonunion and hardware failure. Each millimeter increase in displacement raised nonunion and hardware failure risk by 14.9% (OR = 1.1, P = 0.003) and 14.6% (OR = 1.1, P = 0.003).
CONCLUSIONS: This study supports the future use of initial vertical fracture displacement as a prognostic tool for nonunion and hardware failure after patella open reduction internal fixation. Displacement >2 cm placed patients at high risk for these complications. Nonunion rates were higher in both suture-only and screw-with-suture fixation when compared with other fixation constructs.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.