International Orthopaedics

, Volume 43, Issue 12, pp 2807–2815 | Cite as

Outcomes after locked plating of displaced patella fractures: a prospective case series

  • Alexander EllweinEmail author
  • Helmut Lill
  • Rony-Orijit DeyHazra
  • Tomas Smith
  • Jan Christoph Katthagen
Original Paper



Tension band wiring remains a common treatment for patella fractures, but complication rates are high, with unsatisfactory results. The purpose of this observation study was to evaluate clinical results and complication rates of a novel patella locking plate fixation.


Twenty patients (mean age, 59.2 ± 18 years) with displaced patella fractures were prospectively enrolled. Range of motion, knee scores (Tegner, Lysholm, Kujala), complications, and revision surgeries were assessed six weeks, six months, 12 months, and 24 months after surgery. Results were compared to the situation before trauma in regards to the time of follow-up using a paired sample t test.


According to the OTA classification, the fractures were classified as follows: one A1, four C1, six C2, and nine C3. Range of motion improved from 121° after six weeks to 140°, 141°, and 143° within the follow-up period. While the Tegner, Lysholm, and Kujala scores were 4.1/97/97, respectively, before trauma, they improved from 2.6/80/89 to 3.6/94/89, 3.7/95/94, and 4.1/97/97 within the follow-up period. Three patients had a complication (15%): one fracture dislocation, one reactive bursitis, and one renewed fracture. Four patients reported discomfort or anterior knee pain especially when kneeling on the implant.


The patella locking plate is a safe and effective treatment for patella fractures, including comminuted fractures. Function can be restored within six months after surgery, and the complication rate is low. Nonetheless, the implant can cause discomfort or anterior knee pain especially when kneeling, which can necessitate an implant removal.


Patella fracture Locking plate Tension band wiring Complication SuturePlate 


Compliance with ethical standards

The local ethics committee approved the study protocol. All work complied with the principles laid down in the Declaration of Helsinki. The study was registered at (NCT02015975).

Conflict of interest

H.L. is consultant for Arthrex GmbH. JC.K. is on the speakers’ bureau of Arthrex GmbH. All other authors declare that they have no conflict of interest.


  1. 1.
    Dietz S-O, Hessmann M-H, Gercek E, Rommens P-M (2009) Patella fracture. Oper Orthop Traumatol 21:206–220CrossRefGoogle Scholar
  2. 2.
    van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522CrossRefGoogle Scholar
  3. 3.
    Yang N-P, Chan C-L, Yu I-L et al (2010) Estimated prevalence of orthopaedic fractures in Taiwan - a cross-sectional study based on nationwide insurance data. Injury 41:1266–1272CrossRefGoogle Scholar
  4. 4.
    Wild M, Windolf J, Flohé S (2010) Fractures of the patella. Unfallchirurg 113:401–411 quiz 412 CrossRefGoogle Scholar
  5. 5.
    Braun W, Wiedemann M, Rüter A et al (1993) Indications and results of nonoperative treament of patellar fractures. Clin Orthop Relat Res (289):197–201Google Scholar
  6. 6.
    Boström A (1972) Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 143:1–80CrossRefGoogle Scholar
  7. 7.
    Bostrom MP, Asnis SE, Ernberg JJ et al (1994) Fatigue testing of cerclage stainless steel wire fixation. J Orthop Trauma 8:422–428CrossRefGoogle Scholar
  8. 8.
    Outerbridge R, Dunlop J (1975) The problem of chondromalacia patellae. Clin Orthop Relat Res 110:177–196CrossRefGoogle Scholar
  9. 9.
    Kettelkamp D (1973) Clinical implications of knee biomechanics. Arch Surg 107:406–410CrossRefGoogle Scholar
  10. 10.
    Oestern S, Varoga D, Lippross S et al (2011) Patella dislocation. Unfallchirurg 114:345–358CrossRefGoogle Scholar
  11. 11.
    Labitzke R (1997) Proper and improper tension band fixation exemplified by patellar fracture. Chirurg 68:638–642CrossRefGoogle Scholar
  12. 12.
    Zderic I, Stoffel K, Sommer C et al (2017) Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury 48:1749–1757CrossRefGoogle Scholar
  13. 13.
    Smith ST, Cramer KE, Karges DE et al (1997) Early complications in the operative treatment of patella fractures. J Orthop Trauma 11:183–187CrossRefGoogle Scholar
  14. 14.
    Luna-Pizarro D, Amato D, Arellano F et al (2006) Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial. J Orthop Trauma 20:529–535CrossRefGoogle Scholar
  15. 15.
    Mao N, Liu D, Ni H et al (2013) Comparison of the cable pin system with conventional open surgery for transverse patella fractures. Clin Orthop Relat Res 471:2361–2366CrossRefGoogle Scholar
  16. 16.
    Levack B, Flannagan JP, Hobbs S (1985) Results of surgical treatment of patellar fractures. J Bone Joint Surg Br 67:416–419CrossRefGoogle Scholar
  17. 17.
    Carpenter JE, Kasman RA, Patel N et al (1997) Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma 11:351–356CrossRefGoogle Scholar
  18. 18.
    Wurm S, Augat P, Bühren V (2015) Biomechanical assessment of locked plating for the fixation of Patella fractures. J Orthop Trauma 29:e305–e308CrossRefGoogle Scholar
  19. 19.
    Wurm S, Bühren V, Augat P (2018) Treating patella fractures with a locking patella plate - first clinical results. Injury 49(Suppl 1):S51–S55CrossRefGoogle Scholar
  20. 20.
    Meinberg E, Agel J, Roberts CS et al (2018) Fracture and dislocation classification Compendium-2018. J Orthop Trauma 32:S1–S170CrossRefGoogle Scholar
  21. 21.
    Oestern HJ, Tscherne H (1983) Pathophysiology and classification of soft tissue damage in fractures. Orthopade 12:2–8PubMedGoogle Scholar
  22. 22.
    McLaughlin H (1947) Repair of major tendon ruptures by buried removable suture. Am J Surg 74:758–764CrossRefGoogle Scholar
  23. 23.
    Bartoníček J, Rammelt S (2015) Early history of operative treatment of patellar fractures. Int Orthop 39:2303–2308CrossRefGoogle Scholar
  24. 24.
    Thelen S, Schneppendahl J, Baumgärtner R et al (2013) Cyclic long-term loading of a bilateral fixed-angle plate in comparison with tension band wiring with K-wires or cannulated screws in transverse patella fractures. Knee Surg Sport Traumatol Arthrosc 21:311–317CrossRefGoogle Scholar
  25. 25.
    Thelen S, Schneppendahl J, Jopen E et al (2012) Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury 43:1290–1295CrossRefGoogle Scholar
  26. 26.
    Thelen S, Betsch M, Schneppendahl J et al (2013) Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate. Orthopedics 36:e1437–e1443CrossRefGoogle Scholar
  27. 27.
    Benli IT, Akalin S, Mumcu EF et al (1992) The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation. Kobe J Med Sci 38:233–243PubMedGoogle Scholar
  28. 28.
    Zhu Y, Liu S, Chen W et al (2018) Socioeconomic factors and individual lifestyles influencing the incidence of patella fractures: a national population-based survey in China. Int Orthop 43:687–695CrossRefGoogle Scholar
  29. 29.
    Dy CJ, Little MTM, Berkes MB et al (2012) Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg 73:928–932CrossRefGoogle Scholar
  30. 30.
    Müller M, Allgöwer M, Schneider R, Willenegger H (1991) Manual of internal fixation: techniques recommended by the AO-ASIF. Springer, HeidelbergCrossRefGoogle Scholar
  31. 31.
    Weber M, Janecki C, McLeod P et al (1980) Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am 62:215–220CrossRefGoogle Scholar
  32. 32.
    Catalano JB, Iannacone WM, Marczyk S et al (1995) Open fractures of the patella: long-term functional outcome. J Trauma 39:439–444CrossRefGoogle Scholar
  33. 33.
    Wild M, Eichler C, Thelen S et al (2010) Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring? Clin Biomech (Bristol, Avon) 25:341–347CrossRefGoogle Scholar
  34. 34.
    Wild M, Thelen S, Jungbluth P et al (2011) Fixed-angle plates in patella fractures - a pilot cadaver study. Eur J Med Res 16:41–46CrossRefGoogle Scholar
  35. 35.
    Wild M, Fischer K, Hilsenbeck F et al (2016) Treating patella fractures with a fixed-angle patella plate — a prospective observational study. Injury 47:1737–1743CrossRefGoogle Scholar
  36. 36.
    Moore TB, Sampathi BR, David P et al (2018) Fixed angle plate fixation of comminuted patellar fractures. Injury 49:1203–1207CrossRefGoogle Scholar
  37. 37.
    Volgas D, Dreger TK (2017) The use of mesh plates for difficult fractures of the Patella. J Knee Surg 30:200–203CrossRefGoogle Scholar
  38. 38.
    Kadar A, Sherman H, Drexler M et al (2016) Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop 40:149–154CrossRefGoogle Scholar
  39. 39.
    Lazaro LE, Wellman DS, Pardee NC et al (2013) Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma 27:336–344CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department for Orthopaedic Surgery, Medical School HannoverHannoverGermany
  2. 2.Department for Orthopaedic Surgery and TraumatologyHannoverGermany
  3. 3.Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital Münster, Albert-Schweitzer-CampusMünsterGermany

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