Giuliano Lattanzi, Nicolò Ferullo, Andrea Panfighi, Luca Liverani, Antonio Pompilio Gigante, Raffaele Pascarella, Simone Cerbasi
Contoured dorsal mini-fragment plate fixation may be associated with better functional outcomes at 1-year follow-up than tension band wiring. Lower implant failure and hardware removal rates were observed, although these differences were not statistically significant. Given the observational design, these findings should be considered hypothesis-generating.
PURPOSE: Articular patellar fractures (AO/OTA 34-C1/C2) are commonly treated with internal fixation. This non-randomized prospective observational study aimed to compare clinical and functional outcomes between two osteosynthesis techniques: contoured dorsal mini-fragment plate and tension band wiring.
METHODS: All patients who underwent surgical fixation for transverse articular patellar fractures between November 2023 and January 2025 were prospectively enrolled. Patients were divided into two groups: Group A, treated with a dorsal mini-fragment plate, and Group B, treated with tension band wiring. Demographic data, failure rate, hardware removal rate, and range of motion (ROM) at 1 year postoperatively were compared between groups. In addition, functional outcomes and quality of life were assessed at a minimum follow-up of 1 year using the Kujala Anterior Knee Pain Scale (AKPS) and the 12-Item Short Form Health Survey (SF-12).
RESULTS: A total of 54 patients were included (Group A: n = 24; Group B: n = 30). Compared with Group B, Group A showed a lower failure rate (8.3% vs. 16.7%, p = 0.44; OR 0.45) and a lower rate of hardware removal (4.5% vs. 24.0%, p = 0.11; OR 0.15), although these differences did not reach statistical significance. Functional outcomes were significantly better in Group A, with a greater median postoperative range of motion (105° vs. 100°, p = 0.011) and higher median Kujala scores (84 vs. 75, p = 0.005). Median SF-12 Physical Component Summary (PCS) scores were significantly higher in Group A (45.56 vs. 42.73, p = 0.016), whereas median Mental Component Summary (MCS) scores were comparable between groups (56.56 vs. 56.30, p = 0.788).
CONCLUSION: Contoured dorsal mini-fragment plate fixation may be associated with better functional outcomes at 1-year follow-up than tension band wiring. Lower implant failure and hardware removal rates were observed, although these differences were not statistically significant. Given the observational design, these findings should be considered hypothesis-generating.