Journal of Lumbini Medical College (Dec 2016)
Outcome of Inferior Patellar Pole Avulsion Fractures
Abstract
Introduction: The optimal treatment for inferior pole patella avulsion fractures has still been a topic of debate. The options include (a) internal fixation of the pole fragment and (b) resection of the avulsed fragment and repair of the patellar ligament to the patella. We present the comparative outcomes for patients with displaced inferior pole patella treated by resection and transosseous Ethibond® Krackow suture repair of patellar ligament with open reduction and internal fixation with modified tension band wiring and circumferential wiring. Methods: During a three year period between August 2013 and September 2016, twenty consecutive patients with distal pole fractures of the patella were prospectively enrolled in this study. These patients were divided into two groups. Group-T patients were treated with open reduction and internal fixation with modified tension band wire and group-R patients by resection of the avulsed fragment and reattachment of the patellar ligament to the patella with #5 Ethibond®. Data entry and analysis was done by using SPSS version 20. Anatomical and functional outcome were compared. Results: Consecutive 20 patients were treated either with resection lower patellar pole (n=10) or with open reduction internal fixation with tension band wiring (n=10). Demographics were matched in two groups. Group-T required a longer hospital stay (U=13.5, p=0.005). Complications were seen more often in Goup-T compared to Group-R (p=0.005). Group-R had better scores (Bostman score U=6, p=0.001; SFMA U=7.5, p=0.001) and range of movement (p<0.05). Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had better outcome according to the Bostman and SFMA dysfunction score, shorter hospital stay, and less complications as compared to open reduction and internal fixation with tension band wire and circumferential wiring.
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