Patellar Fixation Following Fracture: A Retrospective Review of Outcomes Following Varying Surgical Interventions

Braden J. Passias1, DO; Anthony J. Melaragno2, BSPS; Jacob J. Triplet1, DO; David B. Johnson1, DO; Benjamin Umbel1, DO; Benjamin C Taylor3, MD

1 Doctors Hospital OhioHealth, 5100 West Broad Street, Columbus, OH, 43228, the United States
2 Ohio University Heritage College of Osteopathic Medicine, Athens, OH, the United States 3 OhioHealth Orthopedic Trauma and Reconstructive Surgeons, 285 East State Street, Suite 500, Columbus, OH, 43215, the United States
Disclaimer: Benjamin C. Taylor, MD is a consultant for, receives royalties from, and is on the speakers’ bureau of ZimmerBiomet, is on the editorial staff of Orthobullets.com, and is on the speakers’ bureau for DepuySynthes. Jacob J. Triplet, David B. Johnson, Braden J. Passias, Benjamin Umbel, Anthony Melaragno have no financial conflicts.
Location: All work was performed at the Grant Medical Center

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Benjamin C Taylor, MD, OhioHealth Orthopedic Trauma and Reconstructive Surgeons, 285 East State Street, Suite 500, Columbus, OH, 43215, the United States.
Email: drbentaylor@gmail.com
Telephone: +1-614-566-7777

Received: April 24, 2019
Revised: May 4, 2019
Accepted: May 23 2019
Published online: December 28, 2019


Purpose: Patella fractures are a common injury in trauma patients and can be treated with a multitude of different fixation methods. With so many fixation techniques available, no current consensus exists on best practices for patients presenting with this injury. The purpose of this analysis is to review the multiple different patella fixation strategies and to evaluate the outcomes and complications associated with each.

Methods: One hundred and fifteen patients who underwent patellar fracture fixation at an urban Level I-Trauma center were retrospectively reviewed. Operative treatment included open reduction and internal fixation with plate and screw devices, tension band wiring (TBW), cannulated screw tension band wiring (CS-TBW), isolated interfragmentary screw fixation, or partial patellectomy with soft tissue repair and tendon advancement. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and post-operative outcome measurements were recorded for each patient assessed in the study.

Results: Results demonstrated that plating techniques had the highest overall rate of union. Furthermore, a significant decrease in implant removal with utilization of isolated suture/wire was appreciated compared to other fixation groups (p < 0.01).

Conclusion: We conclude that plate utilization achieves high radiographic union compared with other fixation methods.

Key words: Patella Fracture; Orthopedic Trauma; Retrospective Review; Extensor Mechanism Disruption; Hardware Removal

© 2019 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Passias BJ, Melaragno AJ, Triplet JJ, Johnson DB, Umbel B, Taylor BC. Patellar Fixation Following Fracture: A Retrospective Review of Outcomes Following Varying Surgical Interventions. International Journal of Orthopaedics 2019; 6(6): 1199-1204 Available from: URL: http://www.ghrnet.org/index.php/ijo/article/view/2766


The patella is the largest sesamoid bone in the body[1]. It serves as a protective shield for the knee joint and enhances the strength of the quadriceps muscle by acting as a fulcrum for knee extension, which plays an essential role in the kinematics of the lower extremity[1,2]. Though these fractures are relatively uncommon, 10.7 per 100,000 people per year[1] and 1% of all skeletal injuries[2-5], they are often encountered following direct impact or from an indirect eccentric contraction. Management of these fractures may be challenging and several factors should be considered when selecting treatment. Patient factors such as previous ambulatory status and medical comorbidities, in addition to physical examination findings of extensor mechanism integrity, fracture displacement, degree of comminution and available bone stock are important.

Fractures of the patella may be treated conservatively or surgically. Conservative management may be ideal for the patient who is non-ambulatory, had a prior failed extensor mechanism, those with an ankylosed joint, or particular fracture characteristics. Typically, this involves immobilization of the extremity in full extension with partial weight bearing for several weeks. If the injury is not amendable to conservative management, then surgical intervention is merited to mitigate disability. However, surgical management of patellar fractures is complicated secondary to its various tendinous attachments, which serve as displacing vectors on fracture fragments making fracture alignment not easily amenable to fixation[2,6]. Such treatments include tension band fixation utilizing K-wires with tension band wiring, circumferential cerclage wiring, cannulated screws with tension band wiring (Figure 1), interfragmentary screw compression with circumferential cerclage wiring, plating, and partial or complete patellectomy[7-10]; each of which has advantages and drawbacks. Moreover, the subcutaneous location of the patella renders its fixation with various implants subject to post-operative symptomatic hardware prominence[7,10-12]. While several small studies have compared outcomes[13-16], a recent Cochrane review of randomized controlled trials[1] concluded that overall evidence is of low quality and insufficient to conclude best treatment method for patella fractures. With paucity in the current literature, a comparison of patella fixation methods is merited.

The purpose of this retrospective review was to report on the clinical and radiographic outcomes of patellar fractures treated with various modalities. To our knowledge, no extensive review of various treatment modalities for patella fractures has been reported in the current literature. A more comprehensive understanding of these constructs may improve postoperative patient outcomes.

Materials and methods

A retrospective chart review was conducted on 115 patients who underwent operative fixation following acute patellar fractures between January 1st, 2010 and January 31st, 2017; all patients were treated by one of five fellowship-trained orthopedic trauma surgeons at an urban Level-1 Trauma Center. Operative treatment included open reduction and internal fixation with plate and screw devices, tension band wiring (TBW), cannulated screw tension band wiring (CS-TBW), isolated interfragmentary screw fixation, or partial patellectomy with soft tissue repair and tendon advancement. Selection of surgical intervention technique was based on surgeon preference and patellar fracture characteristics; this was not randomized or controlled for this investigation. Patients were excluded from the study if they met any of the following criteria: (1) age less than 18 years, (2) having underwent a complete patellectomy, (3) having had previous patellar fracture or extensor mechanism surgery. Electronic and written medical records were utilized to collect patient data, which was assembled in a database (Microsoft Excel, Redmond, WA). Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and post-operative outcome measurements were recorded for each patient assessed in the study. Formal Institutional Review Board (IRB) approval was obtained prior to initiation of this investigation.

Statistical analysis was performed, with means, ranges and confidence intervals calculated for continuous variables and compared using student’s t-tests. Frequencies were calculated for continuous variables and compared using Fisher’s exact test for increased accuracy in small proportion analysis. A significance level of p < 0.05 was set as significant, with a trend defined as a p value being between 0.05 and 0.1.


A total of 115 patients met the inclusion and exclusion criteria, with an average age of 48 years (range, 18-87). Of the patients assessed, 62 patients (53%) were male, 20 patients (17%) had diabetes mellitus, and 19 patients (16%) had a history of osteoporosis. Furthermore, the most common mechanisms of injury were motor vehicle collision and fall; 49% and 41%, respectively. Analysis of demographical data revealed no differences between all the treatment groups except for younger patients, who were more likely to be treated with screw only fixation versus plating. Screw only fixation had an average age of 35 years (range, 26-63), while plating had an average age of 48 years (range, 18-76) (p = 0.02). No statistical significance between groups was otherwise detected (Table 1).

Of the patients enrolled in this investigation, 18 (16%) underwent surgical repair with plate and screws, 24 (20%) with tension band wiring, 15 (13%) with tension band wiring augmented by cannulated screws, 9 (8%) with interfragmentary screws, 24 (21%) with suture/wire repair alone, and 24 (21%) received a combination treatment with two or more of the fixation methods. Radiographic union was defined as the presence of cortical continuity and the progressive resolution of fracture lines on post-operative radiographs. Rates of radiographic union and implant removal for the respective treatment groups are shown in Table 2. Plating techniques had the highest rate of union, and was found to have a trend toward increased union as compared to tension band wiring and suture/wire treatment (84% vs 58%, p = 0.10). There was no difference in radiographic union rate between plating and cannulated screw tension band wiring (84% vs 67%, p = 0.40). A significant decrease in implant removal with suture/wire treatment compared to the other three fixation groups was appreciated (p < 0.01), with no discernable differences between plating, tension band wiring, and cannulated screw tension band wiring (Table 2). No difference in post-operative range of motion, hardware failure, duration of procedure, or length of hospital stay was found in any treatment option.

Table 1 Patient Demographics and Injury Characteristics.
Age (years)47.8 ± 19.0 (18-87)
Sex (Male)62 (52.5%)
Diabetes Mellitus20 (16.9%)
Tobacco Use62 (52.5%)
Osteoporosis History19 (16.1%)
Employed46 (39.0%)
Fully Ambulatory113 (95.8%)
Mechanism of Injury
Motor Vehicle Collision58 (49.1%)
Fall/Crush48 (40.7%)
Direct Blow2 (1.7%)
Other10 (8.5%)
Open Fracture29 (24.6%)
Laterality (Left)57 (48.3%)
Isolated Injury55 (46.6%)
* Categorical variables are given as absolute numbers with percentages in parentheses. Non-categorical variables are given as means ± standard deviations, with ranges in parentheses.

Table 2 Fixation Outcomes.
TechniqueRadiographic Union RateImplant Removal
Tension Band Wiring58.30%50.00%
Tension Band with Cannulated Screws66.60%26.70%
Suture/Wire Repair58.30%4.10%


Patellar fractures account for a considerable portion of traumatic musculoskeletal injuries, and despite a multitude of proposed treatment options, there exists a lack of evidence-based investigations proposing which method of fixation is superior. Plate and screw devices, tension band wiring, cannulated screw tension band wiring, interfragmentary screw fixation, and partial patellectomy and tendon repair are currently the most commonly conducted fixation methods for patellar fractures, with no established consensus on best practices for these patients. Our report demonstrates a trend toward increase union rate with the utilization of plate fixation. Additionally, we demonstrate a significant decrease in implant removal following utilization of suture/wire treatment.

The challenge accompanying patellar fixation lies with its extensive soft tissue connections and subcutaneous location. Daily tasks such as maintaining an erect position, rising from a chair, and ambulation, are of paramount importance on a patient’s quality of life. Because the patella is embedded between two large tendons, the quadriceps and patellar tendons, deforming forces provide a significant challenge when dealing with this matter. This comes not only with obtaining adequate fracture reduction, but providing a repair strong enough to withstand the pull of these deforming forces on a daily basis thereafter. Forces up to five times the body weight are transmitted across the extensor mechanism of the knee[5].

Adult patellar fractures are most commonly classified based on fracture pattern. The position of knee flexion at the time of injury also plays a role in the type of fracture that occurs. With higher degrees of flexion, the proximal aspect of the patella at the patellofemoral joint endures greater stress, which contributes to a higher percentage of proximal pole fractures. Direct force to the knee often results in fracture comminution, and indirect forces are more likely to account for transverse fractures[2]. However, transverse fractures may also result from direct impact, usually with the knee at ninety degrees of flexion. Despite, the mechanism, operative indications for patellar fractures are well established[2,5,17]. Among these indications are extensor mechanism failures, open fractures, pediatric patellar sleeve fractures, and articular step off greater than 2 mm. These fracture characteristics play an important role in selecting treatment modality.

Historically, comminuted patella fractures were managed with total patellectomy[18]. With a better understanding of the importance of this bone and a growing emphasis on maintaining as much patella as possible[2], this procedure is rarely utilized today despite reported satisfactory outcomes[3]. Several surgical fixation strategies have been developed to help manage these fractures and are now frequently employed. Tension band wiring was among the first employed surgical treatments, which allows for the conversion of tension force at the anterior surface of the patella to a compression force at the articular surface[2,9,19,20]. Poor biomechanical strength in vivo led to the exploration of augmenting this tension band wire technique with that of cannulated screws[9,21,22]. Since, tension band wiring positioned through cannulated lag screws has gained in popularity[9,22,23], as it was demonstrated to have superior biomechanical performance compared with anterior tension band wiring with Kirschner wire fixation alone[9,21,24,25]. Additionally, interfragmentary screw fixation has also demonstrated successful use[24]. Yet most recently, patellar plating has demonstrating even greater biomechanical strength than tension band wiring with cannulated screws, promoting it as a popular treatment modality for patella fractures[7,8,26-36]. These plates offer several theoretical advantages, including adequate fixation while maintaining a low rate of hardware prominence and failure, and may be used in difficult fractures that typically undergo poor fixation or even excision/partial patellectomy. This may be a good option particularly for the osteopenic patient[7] (Figure 2).

The fracture characteristic frequently dictates treatment. Generally, fractures that are at either the superior or inferior poles of the patella, or those not amendable to tension band wiring or interfragmentary screw fixation, have been treated with partial patellectomy with variable success[9,17,19,21,22,26-30,37-40]. Classically, transverse fractures without comminution are commonly treated with Kirschner wire fixation with or without cannulated screw utilization[10,12,41]. Several small case series have demonstrated significant rates of tension band failures after early rehabilitation[7,14-16,41]. However newer techniques may reduce the incidence of this implant failure[6,17]. In addition, wire fixation is relatively poor in regards to its biomechanical stability, and the high rates of hardware failure and loss of fracture reduction reveal this to be a relatively poor construct in vivo. Due to these poor results, there has been a movement to create more stable constructs, including the use of cannulated screws, which have been shown to be biomechanically superior in several studies, as well as have clinical success in several recent reviews[9,11,21,22]. However, the use of isolated screws is only recommended in simple fracture patterns in the absence of comminution[10]. Additionally, lag screws are frequently utilized in patellar fractures, most commonly as a substitute to, or in combination with, tension band wiring or for compression of large fragments.

More recently, plating techniques have been described with some considerable success. Previously, we reported on such utilization of plate and screw techniques with successful union rates[7]. Interestingly, no patient required hardware removal secondary to implant prominence. Both variable angle locking plates (X-plates) and mesh plates were used in the study, with a preference towards mesh plating in the setting of comminution. Success of plating techniques compared to TBW and CS-TBW has since been demonstrated[10]. Similarly, plating techniques had the least reported symptomatic hardware[7]. Lastly, with significant comminution, partial or complete patellectomy is considered. Bostman and colleagues compared the outcomes of fragment excision with that of internal fixation for comminuted patellar fractures and found that poor outcomes were observed when greater than 40% of the patella was removed[37]. Care should be taken to leave as much of the intact bone as possible, as well as, avoid resection of the inferior pole due to the largest arterial contribution to the patella entering infero-medially[6]. Total patellectomy, on the other hand, should be avoided when at all possible[37].

Despite several treatment modalities, there are several limitations and drawbacks to their utilization. Due to the superficial nature of the patella, prominence and pain remains problematic and often requires hardware removal[17]. Lazaro and colleagues found an 80% incidence of anterior knee pain following tension band wiring, cannulated screw tension band wiring, or suture fixation, with 37% undergoing implant removal[6]. Hoshino et al. found that patients who were treated with Kirschner wires alone were twice as likely to undergo implant removal than those treated with screw fixation, potentially jeopardizing the repair[12].

There are several limitations to our study. First, it is susceptible to inherent limitations of its retrospective nature. Despite its inherent limitations, it provides a comprehensive review of various patellar fracture fixation methods in a wide-based trauma population. Secondly, selection of treatment was at the discretion of the operating surgeon. As this was not a blinded study, surgeon preference and familiarity with the implant use may influence postoperative outcomes. Notwithstanding similar demographic patient profiles and operative details, we were unable to discern any differences in rates of hardware removal, length of hospital stay, or other complication rates. Furthermore, it is important to note that radiographic outcomes do not necessarily parallel that of clinical outcomes. Although radiographic union and anatomic fracture reduction will commonly correlate to satisfactory clinical performance, future research could investigate patient-reported functional outcomes a period after surgery, which were not evaluated in this study.


Patellar fractures may pose significant challenges for the treating surgeon. In the largest review of surgically managed patellar fracture fixation utilizing varying modalities, our report suggests an increased radiographic union following plating. Despite hardware removal being one of the most commonly reported complications of patellar fracture repair, no significant differences in hardware removal between plating, TBW, and CS-TBW was observed. Larger prospective trials comparing the various modalities are needed.


1. Sayum Filho J, Lenza M, Teixeira de Carvalho R, Pires OG, Cohen M, Belloti JC. Interventions for treating fractures of the patella in adults. Cochrane Database Syst Rev. 2015(2): CD009651. [PMID: 25723760]; [DOI: 10.1002/14651858.CD009651.pub2]

2. Scolaro J, Bernstein J, Ahn J. Patellar fractures. Clinical orthopaedics and related research. 2011; 469(4): 1213-1215. [PMID: 20740335]; [PMCID: PMC3048243]; [DOI: 10.1007/s11999-010-1537-8]

3. Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instructional course lectures. 1994; 43: 97-108. [PMID: 9097140

4. Huang SL, Xue JL, Gao ZQ, Lan BS. Management of patellar fracture with titanium cable cerclage. Medicine (Baltimore). 2017; 96(44): e8525. [PMID: 29095314]; [PMCID: PMC5682833]; [DOI: 10.1097/MD.0000000000008525]

5. Kakazu R, Archdeacon MT. Surgical Management of Patellar Fractures. Orthop Clin North Am. 2016; 47(1): 77-83. [PMID: 26614923]; [DOI: 10.1016/j.ocl.2015.08.010]

6. Lazaro LE, Wellman DS, Klinger CE, et al. Quantitative and qualitative assessment of bone perfusion and arterial contributions in a patellar fracture model using gadolinium-enhanced magnetic resonance imaging: a cadaveric study. J Bone Joint Surg Am. 2013; 95(19): e1401-1407. [PMID: 24088975]; [DOI: 10.2106/JBJS.L.00401]

7. Taylor BC, Mehta S, Castaneda J, French BG, Blanchard C. Plating of patella fractures: techniques and outcomes. Journal of orthopaedic trauma. 2014; 28(9): e231-235. [PMID: 24343252]; [DOI: 10.1097/BOT.0000000000000039]

8. Matthews B, Hazratwala K, Barroso-Rosa S. Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report. Geriatr Orthop Surg Rehabil. 2017; 8(3): 135-144. [PMID: 28835869]; [PMCID: PMC5557194]; [DOI: 10.1177/2151458517710517]

9. Carpenter JE, Kasman RA, Patel N, Lee ML, Goldstein SA. Biomechanical evaluation of current patella fracture fixation techniques. Journal of orthopaedic trauma. 1997; 11(5): 351-356. [PMID: 9294799]; [DOI: 10.1097/00005131-199707000-00009]

10. Meng D, Xu P, Shen D, Chen Y, Zhu C, Hou C, Lin H, Ouyang Y. A clinical comparison study of three different methods for treatment of transverse patellar fractures. J Orthop Sci. 2019 Jan; 24(1): 142-146.. [PMID: 30316657]; [DOI: 10.1016/j.jos.2018.08.026]

11. Lazaro LE, Wellman DS, Sauro G, Pardee NC, Berkes MB, Little MT, Nguyen JT, Helfet DL, Lorich DG. Outcomes after operative fixation of complete articular patellar fractures: assessment of functional impairment. J Bone Joint Surg Am. 2013; 95(14): e96 91-98. [PMID: 23864187]; [DOI: 10.2106/JBJS.L.00012]

12. Hoshino CM, Tran W, Tiberi JV, Black MH, Li BH, Gold SM, Navarro RA. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am. 2013; 95(7): 653-659. [PMID: 23553301]; [DOI: 10.2106/JBJS.K.01549]

13. Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet Disord. 2015; 16: 282. [PMID: 26445425]; [PMCID: PMC4596291]; [DOI: 10.1186/s12891-015-0719-7]

14. Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early complications in the operative treatment of patella fractures. Journal of orthopaedic trauma. 1997; 11(3): 183-187. [PMID: 9181501]; [DOI: 10.1097/00005131-199704000-00008]

15. Choi HR, Min KD, Choi SW, Lee BI. Migration to the popliteal fossa of broken wires from a fixed patellar fracture. The Knee. 2008; 15(6): 491-493. [PMID: 18752955]; [DOI: 10.1016/j.knee.2008.06.005]

16. LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. Journal of orthopaedic trauma. 2012; 26(7): 422-426. [PMID: 22183197]; [DOI: 10.1097/BOT.0b013e318228c1a1]

17. Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg. 2011; 19(4): 198-207. [PMID: 21464213]; [DOI: 10.5435/00124635-201104000-00004]

18. Macausland WR. Total patellectomy: report of twenty-eight cases. Am J Surg. 1953; 87(2): 221-226. [PMID: 13114557]; [DOI: 10.1016/0002-9610(54)90544-9]

19. Weber MJ, Janecki CJ, McLeod P, Nelson CL, Thompson JA. Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am. 1980; 62(2): 215-220. [PMID: 7358752]

20. Hambright DS, Walley KC, Hall A, Appleton PT, Rodriguez EK. Revisiting Tension Band Fixation for Difficult Patellar Fractures. Journal of orthopaedic trauma. 2017; 31(2): e66-e72. [PMID: 28129272]; [DOI: 10.1097/BOT.0000000000000686]

21. Chang SM, Ji XL. Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws. Journal of orthopaedic trauma. 2011; 25(6): 366-370. [PMID: 21577073]; [DOI: 10.1097/BOT.0b013e3181dd8f15]

22. Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. Journal of orthopaedic trauma. 1997; 11(8): 573-576. [PMID: 9415863]; [DOI: 10.1097/00005131-199711000-00005]

23. Khan I, Dar MY, Rashid S, Butt MF. Internal Fixation of Transverse Patella Fractures Using Cannulated Cancellous Screws with Anterior Tension Band Wiring. Malays Orthop J. 2016; 10(2): 21-26.

24. Dargel J, Gick S, Mader K, Koebke J, Pennig D. Biomechanical comparison of tension band- and interfragmentary screw fixation with a new implant in transverse patella fractures. Injury. 2010; 41(2): 156-160. [PMID: 19665707]; [DOI: 10.1016/j.injury.2009.07.007]

25. Zderic I, Stoffel K, Sommer C, Hontzsch D, Gueorguiev B. Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury. 2017; 48(8): 1749-1757. [PMID: 28622833]; [DOI: 10.1016/j.injury.2017.05.037]

26. Wild M, Eichler C, Thelen S, Jungbluth P, Windolf J, Hakimi M. Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring? Clin Biomech (Bristol, Avon). 2010; 25(4): 341-347. [PMID: 20096491]; [DOI: 10.1016/j.clinbiomech.2009.12.010]

27. Thelen S, Schneppendahl J, Jopen E, Eichler C, Koebke J, Schönau E, Hakimi M, Windolf J, Wild M. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury. 2012; 43(8): 1290-1295. [PMID: 22608600]; [DOI: 10.1016/j.injury.2012.04.020]

28. Thelen S, Schneppendahl J, Baumgärtner R, Eichler C, Koebke J, Betsch M, Hakimi M, Windolf J, Wild M. 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 Sports Traumatol Arthrosc. 2013; 21(2): 311-317. [PMID: 22491707]; [DOI: 10.1007/s00167-012-1999-1]

29. Wild M, Thelen S, Jungbluth P, Betsch M, Miersch D, Windolf J, Hakimi M. Fixed-angle plates in patella fractures - a pilot cadaver study. Eur J Med Res. 2011; 16(1): 41-46. [PMID: 21345769]; [PMCID: PMC3351948]; [DOI: 10.1186/2047-783x-16-1-41]

30. Krkovic M, Bombac D, Balazic M, Kosel F, Hribernik M, Senekovic V, Brojan M. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament--a biomechanical analysis. The Knee. 2007; 14(3): 188-193. [PMID: 17433694]; [DOI: 10.1016/j.knee.2007.03.004]

31. Wurm S, Augat P, Buhren V. Biomechanical Assessment of Locked Plating for the Fixation of Patella Fractures. Journal of orthopaedic trauma. 2015; 29(9): e305-308. [PMID: 26299810]; [DOI: 10.1097/BOT.0000000000000309]

32. Verbeek DO, Hickerson LE, Warner SJ, Helfet DL, Lorich DG. Low Profile Mesh Plating for Patella Fractures: Video of a Novel Surgical Technique. Journal of orthopaedic trauma. 2016; 30 Suppl 2: S32-33. [PMID: 27441934]; [DOI: 10.1097/BOT.0000000000000589]

33. Siljander MP, Vara AD, Koueiter DM, Wiater BP, Wiater PJ. Novel Anterior Plating Technique for Patella Fracture Fixation. Orthopedics. 2017; 40(4): e739-e743. [PMID: 28632289]; [DOI: 10.3928/01477447-20170615-02]

34. Lorich DG1, Fabricant PD, Sauro G, Lazaro LE, Thacher RR, Garner MR, Warner SJ. Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study. Journal of orthopaedic trauma. 2017; 31(5): 241-247. [PMID: 28166170]; [DOI: 10.1097/BOT.0000000000000787]

35. Ellwein A, Lill H, Jensen G, Gruner A, Katthagen JC. [Plate osteosynthesis after patellar fracture - the technique and initial results of a prospective study]. Unfallchirurg. 2017; 120(9): 753-760. [PMID: 27435484]; [DOI: 10.1007/s00113-016-0213-1]

36. Volgas D, Dreger TK. The Use of Mesh Plates for Difficult Fractures of the Patella. J Knee Surg. 2017; 30(3): 200-203. [PMID: 28192827]; [DOI: 10.1055/s-0037-1598078]

37. Bostman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury. 1981; 13(3): 196-202. [PMID: 7327739]; [DOI: 10.1016/0020-1383(81)90238-2]

38. Matejcic A, Puljiz Z, Elabjer E, Bekavac-Beslin M, Ledinsky M. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg. 2008; 128(4): 403-408. [PMID: 18270723]; [DOI: 10.1007/s00402-008-0572-3]

39. Kastelec M, Veselko M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg Am. 2004; 86-A(4): 696-701. [PMID: 15069132]; [DOI: 10.2106/00004623-200404000-00005]

40. Gardner MJ, Griffith MH, Lawrence BD, Lorich DG. Complete exposure of the articular surface for fixation of patellar fractures. Journal of orthopaedic trauma. 2005; 19(2): 118-123. [PMID: 15677928]; [DOI: 10.1097/00005131-200502000-00008]

41. Schuett DJ, Hake ME, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Current Treatment Strategies for Patella Fractures. Orthopedics. 2015; 38(6): 377-384. [PMID: 26091213]; [DOI: 10.3928/01477447-20150603-05]


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.