Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal

Objectives: The purpose of this study is to report the results of open reduction internal fixation of patella fractures (OTA 34 A-C) using cannulated lag screws and FiberWire (R) (Arthrex, Naples, FL, USA) with regard to union and symptomatic implant removal. Design: Retrospective review of prospectively collected database. Setting: Urban Level 1 trauma center and Level 2 trauma center Methods: All displaced intra-articular patella fractures (OTA 34 A-C) treated with ORIF by cannulated lag screws and FiberWire (R) tension band/cerclage between January 1, 2009 and August 1, 2018. Three hundred and eighty seven consecutive patients were identified. Fifty fractures were included in the final analysis. Main Outcome Measurement: All patients were followed to clinical and radiographic union. Nonunion was defined as lack of clinical and radiographic union, fracture displacement, and/or return to OR for revision surgery. Rate of symptomatic implant removal was recorded. Results: Average age was 57.7 years (range 21-86). Average follow up was 20.6 months (range 6-98 months). Average time to clinical and radiographic union was 3.1 months (range 3-7 months). Four fractures were open. There was a 96% (48/50) rate of primary union, with one patients requiring revision surgery to achieve union, and one developing an asymptomatic radiographic nonunion. The rate of symptomatic implant removal was 8% (4/50). Only 1 of the 4 was operated for a prominent suture knot, and the remaining 3 were for prominent screw removal. Knee range of motion averaged 0.37 degrees extension to 119 degrees flexion (range, 0-150 degrees). Conclusion: Patella fractures can be treated with cannulated lag screws and FiberWire (R) with a high rate of primary union (96%) and a low rate of symptomatic implant removal (8%). The implant removal rate compares favorably with alternative constructs, with an equivalent rate of fracture union. (c) 2019 Elsevier Ltd. All rights reserved.