Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures

Abstract

Background: The tension-band technique, with Kirschner wires or cannulated screws, is one of the most commonly used fixation techniques for patellar fractures. However, it may be not useful for inferior patellar pole fractures as it may lead to fragment reduction loss and fixation failure. We present a surgical technique that combines a miniplate with tension band wiring for inferior patellar pole avulsion fractures and report surgical outcomes.

Patients and methods: Between June 2012 and May 2016, 17 consecutive patients (mean age: 51 years) with inferior patellar pole fractures (AO/OTA 34-A1) were treated operatively with a miniature plate in combination with tension band wiring. The final range of motion, bone union time, and Bostman score were the primary outcome measures.

Results: The bone union time was 9.5 weeks on average after surgery (range: 8-12 weeks). No patient had loss of reduction or implant failure. There were no cases of irritation or other complications from the implant. At the final follow-up, the average range of motion arc was 128.24° (range: 105-140°). The mean Bostman score at the last follow-up was 28.1 points (range: 25-30 points). All patients showed excellent or good results 1 year after surgery.

Conclusion: The combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures provides stable flexion, allows for early range of motion, and provides excellent results in terms of knee function.

Keywords: Augmented miniplate; Inferior patellar pole avulsion fractures; Modified tension-band.