Session V - Knee / Tibia

Fri., 10/11/13 Knee/Tibia, PAPER #60, 2:47 pm OTA 2013

•Fix It or Discard It? A Retrospective Review of Functional Outcomes After Surgically Treated Patellar Fractures Comparing Open Reduction and Internal Fixation With Partial Patellectomy

Nicholas Bonnaig, MD; Chris Casstevens, MD; Michael T. Archdeacon, MD, MSE;
University of Cincinnati Department of Orthopaedic Surgery, Cincinnati, Ohio, USA

Background/Purpose: The goals of surgical treatment of patellar fractures are to provide a congruous articular surface and restore the quadriceps extensor mechanism. To achieve these goals open reduction and internal fixation (ORIF) is the operative technique of choice when anatomic reduction is possible. In comminuted fractures where some fragments are unreconstructable, partial patellectomy (PP) offers an alternative means of restoring the extensor mechanism. The prognosis for these procedures is not clear; thus, the goal of this study was to compare functional outcomes of patients treated with ORIF to those treated with PP.

Methods: We identified 73 patients with isolated displaced patella fractures who underwent surgical treatment between 2002 and 2009 at our institution. Of the 73 qualifying patients, 52 patients (71%) with isolated unilateral patellar fractures with a minimum of 1-year follow- up agreed to participate and were enrolled in the study. Patients completed outcome questionnaires, visual analog pain scale (VAS), and participated in a physical exam including evaluation of gait, passive range of motion and the presence or absence of an extensor lag. Standard AP and lateral radiographs were also collected to assess fracture healing. Outcome instruments included the Knee Outcome Survey – Activities of Daily Living scale (KOS-ADLS), Short Form-36 (SF-36) Health Survey, and Short Musculoskeletal Function Assessment survey (SMFA).

Results: Of the 52 patients who agreed to participate, 26 underwent partial patellectomy and 26 underwent ORIF. There were no significant differences in age, sex, or preinjury functional status between the two groups. The mean follow-up time was 35 months in the PP group and 33 months in the ORIF group. There were no significant differences in any of the functional outcome instruments including KOS-ADSS (ORIF: 64.1 ± 11 vs PP: 62.1 ± 7.9; P = 0.76), SF-36 Physical Component score (ORIF: 40.8 ± 5.4, vs PP: 41.1 ± 5.2; P = 0.94), SF-36 Mental Component (ORIF: 47.7 ± 5.1 vs PP: 51.8 ± 4.9; P = 0.19), SMFA Function Index (ORIF: 28.6 ± 9.1 vs PP: 27.7 ± 6.7; P = 0.78) or SMFA Bother Index (ORIF: 26.0 ± 9.7 vs PP: 23.6 ± 8.8; P = 0.72). There was also no significant difference in pain as assessed by VAS (ORIF: 2.8 ± 1.35 vs PP: 2.9 ± 1.0; P = 0.27). There were more patients in the ORIF group who had an extensor lag greater than 5° at follow-up; however, this did not achieve statistical significance (ORIF: 2/26 [7%] vs PP: 5/26 [19%]; P = 0.42). There was no significant difference in total range of motion between the two groups (ORIF: 114 ± 27° vs PP: 119 ± 17°; P = 0.42). Complications included 14 secondary procedures for removal of hardware (ORIF: 8/26 [31%] vs 6/26 [23%]; P = 0.76), 4 nonunions (ORIF: 3/26 [12%] vs PP: 1/26 [3.8%]; P = 0.6), and 2 incidences of knee arthrofibrosis (ORIF: 1/26 [4%] vs PP: 1/26 [4%]; P = 1.0).

Conclusion: This study demonstrates that functional impairment persists after surgical treatment of patellar fractures. Both ORIF and PP demonstrated similar final range of motion, functional scores, and complication rates. Despite its purported benefits, in this study ORIF did not result in superior outcomes compared to PP.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.