SUTURE FIXATION VERSUS METALLIC CERCLAGE FOR ARTICULAR PATELLAR FRACTURE: A MINIMUM 1-YEAR, RETROSPECTIVE COMPARATIVE STUDY

M. Alessio-Mazzola¹ , S. Ahmadi², G. Placella³, S. Mosca³ , M. Conca¹, V. Salini³

¹ IRCCS San Raffaele Hospital, Milan, Italy
² George Washington University, School of Medicine and Health Sciences, Washington, USA
³ Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy

Correspondence to:

Journal of Orthopedics 2022 May-Aug; 14(2): 63-69

Received: 29 March 2022 Accepted: 1 May 2022

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Abstract

Surgical treatment of patellar fractures with traditional metallic wires results in high rates of complications, with many patients requiring reoperations. Non-metallic implants for the fixation of patellar fractures have shown promising results. This study compares the outcomes of surgical fixation of patellar fractures with metallic wires to suture fixation. Patients with closed patellar fractures requiring surgical fixation were treated with 1.25 mm cerclage wire or suture fixation. Inclusion criteria were fractures with an intra-articular step-off >2mm, displacement >4mm, or impairment of the extensor mechanism. Outcomes were Kujala and WOMAC scores, ROM, and prevalence of postoperative complications. Failure was defined as the need for revision surgery, loss of reduction, malunion or non-union, or poor outcome. The radiographic examination assessed patellar height, radiographic union, secondary displacement, and implant breakage. Thirty-eight patients underwent surgical fixation with metallic cerclage wire, while 32 patients underwent suture fixation with a mean follow-up of 46.6 ± 24.2 (range: 12 to 100) months. No clinical or radiological differences were seen at the final follow-up evaluation. No significant differences among reported complications were found. Patients who underwent metallic fixation experienced significantly higher reoperation rates (p<0.001). Surgical fixation of displaced articular patellar fractures showed no significant differences in complication rates and clinical and radiographical outcomes when treated with metallic cerclage wires compared to suture fixation. However, patients treated with metallic wire fixation had significantly higher reoperation rates. Further studies are requested to thoroughly investigate the results and indications of suture fixation.

Keywords: fibrewire suture, metallic cerclage wire, patellar fracture, surgical fixation, symptomatic hardware