Introduction
Patella fractures comprise 1% of all fractures encountered in the emergency department, and only a third of these require surgical intervention. Among patellar fractures treated surgically, approximately 20% involve the inferior patellar pole3. Historically, a debate existed between resection of the inferior pole versus surgical reduction and fixation. Currently, clinical and biomechanical studies have provided definitive evidence that resection disrupts the extensor mechanism by decreasing the lever arm at the knee joint. Operative fixation of displaced patella fractures has now become the standard of care for these injuries.
The Modified Anterior Tension Band technique with Kirschner wires (K-wires) is one of the most common methods used for fixation of simple mid-pole patella fractures. Although the K-wire and tension band technique remains popular, patients frequently complain of discomfort secondary to prominent hardware, leading to high rates of removal of hardware (ROH). Other techniques, such as the fixed angle plate and the basket plate, intended for use in distal pole fractures, have been developed. These alternatives have yet to supplant techniques involving tension banding, which are still considered the gold-standard for fracture care. Furthermore, some comminuted and inferior pole fractures are not amenable to standard fixation techniques. Recent studies have suggested that sutures such as 5- Ethibond and Fiberwire are similar in strength to, yet avoid the irritation associated with, 18-gauge stainless steel wires.
This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. We hypothesize there will be no observable difference in outcomes between the two groups.