Comparison of Patella Plating Versus Tension Band Wiring for the Treatment of Unstable Patellar Fractures

Patellar fractures are a common injury that can cause significant pain and disability. Conventional treatment options frequently include tension band wiring (TBW) with or without axial K-Wires or through cannulated screws. However, tension band wiring does have its issues, including implant prominence and frequent reoperation rates, especially for comminuted patella fractures.

More recently, plate fixation has become increasingly more prevalent in the past decade. Initially, this began with small fragment or mini-fragment plates; which progressed to mesh locking plates and now, anatomical locking patella plates. Biomechanical studies have shown greater loads to failure, less fracture gapping or fracture displacement with locking plate fixation compared to TBW. Its low profile construct and round edges may be more tolerable to patients and less prominent than TBW. Furthermore, another possible advantage of plate fixation is the avoidance of quadricep and patellar tendon insertion scarring, as they do not need to be dissected or passed through for fixation as in TBW. This is the first randomized controlled trial comparing anatomical locking plate fixation and conventional tension band wiring for patella fractures to be performed. This study aims to compare the efficacy and safety of these two methods in the treatment of patellar fractures.

Inclusion criteria

• Aged 18 years or older
• Diagnosed with an isolated closed injury, displaced, unstable fracture with displacement >2mm (AO/OTA Classification 34-B and C with surgical indication)
• Able to give consent

Exclusion criteria

• History of previous knee surgery
• Poly trauma,
• Ongoing malignancy
• Pre-existing severe knee osteoarthritis (>KL stage 4)
• Stroke
• Other neurological conditions/injuries to the lower limb
• Unfit for surgical anaesthesia
• Non-ambulatory
• Unable to consent or follow commands