Surgical treatment of inferior pole fractures of the patella: a systematic review

Chih-Hsun Chang; Chien-An Shih; Fa-Chuan Kuan; Chih-Kai Hong; Wei-Ren Su; Kai-Lan Hsu

doi:10.1186/s40634-023-00622-y

Surgical treatment of inferior pole fractures of the patella: a systematic review

J Exp Orthop. 2023 Jun 1;10(1):58. doi: 10.1186/s40634-023-00622-y.

Authors

Chih-Hsun Chang^{1

2

3}, Chien-An Shih^{1

3}, Fa-Chuan Kuan^{1

3

4}, Chih-Kai Hong^{1

2

3}, Wei-Ren Su^{1

3}, Kai-Lan Hsu^{5

6

7

8}

Affiliations

¹ Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C.
² Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan.
³ Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan.
⁵ Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C.. dulendulen@gmail.com.
⁶ Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. dulendulen@gmail.com.
⁷ Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan. dulendulen@gmail.com.
⁸ Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. dulendulen@gmail.com.

Abstract

Purpose: This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques.

Method: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications.

Results: A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case-control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11-90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device.

Conclusion: Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.

Keywords: Distal pole; Inferior pole; Lower pole; Patellar fracture; Systematic review.

Publication types

Review