Fixation of patella fractures with a minimally invasive tensioned wire method: compressive external fixation.

BACKGROUND

Current fixation methods of patella fractures are associated with hardware prominence, infection, and failure of fixation. These complications necessitate repeat surgical treatment, increase costs, and limit function. We investigated whether a novel device can effectively treat patella fractures with few complications.

METHODS

A consecutive series of patients with displaced patella fractures with transverse and select other patterns were treated with the technique of compressive external fixation (CEF), a device based on an external tensioned wire construct. Patients were allowed unrestricted motion and weight bearing postoperatively. Patient outcomes were evaluated retrospectively.

RESULTS

Eighty-four fractures (26 open) were treated with CEF with 23 performed percutaneously. All of the fractures attained union. The device was removed in the office at 6 weeks. Sixty-one patients regained excellent motion with a mean Insall knee score of 97 points, at an average follow-up of 4 years. Minor complications presented in 11% of patients but did not affect the overall outcome. Complications included minor wire irritation in 14 patients and one case of poor knee motion in a patient presenting with fibroankylosis of the joint.

CONCLUSION

Treatment using the CEF technique is a safe and effective method of treatment of patella fractures with advantages over traditional forms of fixation particularly in cases with a poor soft tissue envelope, salvage situations, and in locations with limited resources. It allows for rapid recovery with minimal complications and no secondary surgery. Its use should be considered in the treatment of these injuries.

LEVEL OF EVIDENCE: V, therapeutic study.