Table 1.
Summary of Literature.
| Authors | Year | n | Type of Evidence | Level | Aim | AO Fracture Classification | Method of Fixation | Findings | Average Age |
|---|---|---|---|---|---|---|---|---|---|
| Smith et al | 1997 | 51 | Retrospective cohort series | 3 | Examined factors surrounding early failure of operative treatment of patella fracture | C1 x 51 (9 with comminution) | 38 TBW, Tensioned cable and K-wire in 11, TBW and cannulated screws x2 | 32 nonoperatively treated, TBW AO used in all but 3 cases, WBAT in extension brace, loss of reduction in 11 fractures, 9 patients required hardware removal, 4 complete failures due to patient noncompliance. 5 failures associated with technical aspects of the operation, that is, improper placement and not enough tension | 48 |
| Klassen | 1997 | 20 | Retrospective cohort series | 3 | Operative versus nonoperatively managed delayed union | B type 4, C1.1 7, C1.2 x 4, C1.3 2, C3 x 3 | TBW x 6, Bunnell wiring x 1, Cerclage x 1, Screw fixation x 1 | With nonunion average age 38, nonoperative in 7, and operative in 13, 1 persistent nonunion, operative management on nonunion increases functional outcome scores and can be expected to unite | 38 |
| Shabat et al | 2003 | 68 | Retrospective cohort study | 4 | Examined causality, compared operative versus nonoperative patella fracture in older patients | Surgical treatment better than nonsurgical | |||
| Shabat et al | 2004 | 14 | Retrospective case series | 4 | Outcomes of operatively managed primary patella fracture in elderly patients | Not Stated—10 conservative, 58 operative, and 45 comminuted | TBW | Operatively treated patella fracture with tension band wiring followed by cast immobilization for 6 weeks, all patients > 80 years age, average 83.3, all patients treated with ORIF and TBW. Severe limitation of range of motion noted requiring extensive physio, only 4 patients regained full extension | 83.3 |
| Kastelec and Veselko | 2004 | 28 | Retrospective cohort series | 3 | Compared distal pole resection with ORIF with mesh for distal pole fractures | C3.1 (excluded comminution) | Mesh versus PP | ORIF with Mesh had early ROM and weight bearing, better function outcomes and maintained patella ligament length. PP group had cast immobilization, worse functional outcome, and significantly shorter patella ligament | Avg 55 Range 11-77 |
| Huang et al | 2012 | 3 | Case series | 4 | Modified basket plate in inferior pole fractures | C1.3 x 3 | Mesh over inferior pole | Good clinical outcomes in all patients, metalware removed in 1 patient | 54, 87, and 89 |
| Eggink and Jaarsma | 2011 | 60 | Retrospective cohort series | 3 | Compared proximal bend TBW with distal and proximal bend TBW | C1 x 20, C2 x 9, C3 x 25, A1 x 6 | TBW | 60 total (40 followed up) 9 failures of fixation, 3 migration of K-wires, 6 insufficient tension, concluded that it is better to bend the K-wires proximally and distally | 44.9 |
| Dy et al | 2012 | 24 studies | Meta-analysis | 3 | Examined reoperation, nonunion and infection rates in patella fractures | 737 patella fractures | Not recorded | 737 patella fractures, reoperation common in 33.6%, age gender, operative technique, or date of publication did not influence the result | Not Specified |
| Lebrun16 | 2012 | 40 patients | Case series | 4 | Obtained patient reported outcome scores post patella fracture | C1 30%, C2 15%, C3 55% | TBW+Kwire 15, TBW through screws 10, longtidutinal anterior banding 2, PP 13 | 27 operated, 14 required hardware removal, study e-mailed questionnaires to patients then reviewed them | 46.3 |
| Miller et al | 2012 | 13 failures | Retrospective cohort series | 4 | Factors predicting failure of fixation | Type Ax1, Type Bx0 Type C x 12 | Screws and K-wires | 13 patients with failure of fixation examined, concluded that screws with wire is at least as good as TBW/K wire | 65 in failure group |
| Lazaro et al | 2013 | 30 | Retrospective case series | 4 | Outcomes of operatively managed primary patella fracture | C1.3 x 2 C2.1 x 2 C2.2 x 2 C2.3 x 2 C3.1 x 11 C3.2 x 11 | 12-month follow-up of 30 patella fractures, found significant functional impairment after surgery | 60.2 | |
| Taylor et al | 2014 | 8 | Case series | 4 | Plating of patella fractures techniques and outcomes | C3 x 6 | X-Plate 5 fractures, Mesh 2 | All patients healed without complication, 1 small undisplaced fragment in 1 patient | 47.4 |
| Hao et al | 2015 | 29 | Prospective case series | 4 | Outcomes claw fixation of patella fracture | C1 and C2 | Ti, Ni, SMA claw fixation memory alloy fixation | Ti, Ni, SMA claw fixation in 34-C1 and 34-C2 type fractures. Average age 43, Follow-up 11.48 months, No complications of management | 43 |
| Houdek et al | 2015 | 113 | Retrospective cohort study | 3 | Effects of previous patella fracture on TKA | Not specified | ORIF, PP, TP, and CM | Previous patella fracture leads to higher rates of MUA, limited ROM, and atherofibrosis. No increased revision rate | 67 |
| Kadar et al | 2015 | 188 | Retrospective case series | 4 | Predictors of nonunion, reoperation, and infection | A1 x 9 C1 x73, C1.2/1.3 x65 C3 x 33, Bx8 | Average follow-up 908 days, 6.9 (13p) infection, 1.6 (3p) nonunion, 42% required second operation, TBW more frequently associated with requiring a second operation. History of CVA increase risk of infection -old and nonunion 14-fold, Diabetics 8 × more likely to develop infection | 56 | |
| Bonnaig | 2014 | 52 | Retrospective cohort study | 3 | Compared partial patellectomy with ORIF | C1.1 x 19 C1.2 x 26 C3 x5 | Partial patellectomy or TBW with K-wires/Cannulated Screws | 26 patella plasty and 26 ORIF, no significant difference in the functional outcome scores for both groups, both did poorly | 43.8 PP and 44.8 ORIF |
| Lorich et al | 2015 | 9 | Retrospective case series | 4 | Mesh plating | 2 x 34 C1 7 x 34 C3 | Synthes 2.4 mm Mesh | Allowed full weight bearing, ROM allowed at 4 weeks. 2 × Contralateral DVT, Mean time to union of 23 weeks and all achieved union | Avg 65 Range 50 to 86 |
| Chen et al | 2013 | 25 | Matched cohort | 3 | Transosseous-braided suture | 14 x C1 2 x C2 9 x C3 | No.5 Ticron suture | Varied to surgeon preference, splinted for 0 to 6 weeks | 59.6 |
| RCT in Cochrane review | |||||||||
| Juutilainen17 | 1995 | 9 | RCT | 1 | See Cochrane review for full assessment | Prospective RCT, biodegradable versus metallic, polyglycolide acid screws and biodegradable wire. Excluded fractures with more than 3 fragments, all metallic implants removed after 1 year | |||
| Gunal18 | 1997 | 28 | RCT | 1 | See Cochrane review for full assessment | 12 patellectomy with advancement, 18 patelectomy, Mean age 28.3, All communited fractures. Follow-up mean 4.2 years. Nonvalidated scoring system | 28.3 | ||
| Chen19 | 1998 | 38 | RCT | 1 | See Cochrane review for full assessment | 2 years follow-up, RCT (used biopoly and biofix anchors, compared to metal. Severely comminuted fractures excluded). No grading of patella fracture, No difference found between the 2 groups | 46 | ||
| Luna-Pizzaro et al | 2006 | 53 | RCT | 1 | See Cochrane review for full assessment | 26 PCOS and 26 Standard. Excluded comminuted, fragmented, or osteoporotic patients by design. Less pain and better early results with PCOS Percutaneous fixation versus open, follow-up 2 years, Average age 47 (16-74), Used AO classification, only dealt with transverse and distal type fractures | 47 | ||
| Mao et al | 2013 | 39 | RCT | 1 | See Cochrane review for full assessment | Age 18 to 65 (Avg 41.8) Percutaneous fixation using cable pin system versus standard. 20 percutaneous, 19 open. Excluded comminuted fractures | 41.8 | ||
Abbreviations: AO, Arbeitsgemeinschaft für Osteosynthesefragen; CM, Conservative management; DVT, Deep vein thrombosis; MUA, Manipulation under anesthesia; ORIF, open reduction internal fixation; PCOS, percutaneous osteosynthesis; PP, Partial patellectomy; RCT, randomized control trial; ROM, range of motion; TBW, tension band wire; TP, Total patellectomy; WBAT, Weight bear as tolerated.