Radiographic and Functional Outcomes Following Resorbable Screw-Augmented Suture Fixation vs. All-Suture Fixation of Mid-pole Patellar Fractures: A Comparative Case Series

Purpose Midpole patellar fractures are traditionally fixed with an "11-8" metal tension band construct. However, this technique is rife with implant-related complications. This study aims to evaluate the radiographic and functional outcomes following "all-suture" fixation of mid-pole patellar fractures as compared to resorbable screw-augmented suture fixation. Methods We retrospectively studied a consecutive series of 18 patients, 9 each with mid-pole patellar fractures treated with all-suture fixation or suture fixation augmented with bioabsorbable cancellous screws in our institution. The hybrid fixation cohort was significantly older (p<0.01). Radiographic and functional outcomes, such as time to union, postoperative range of motion (ROM), and the presence of complications such as fracture displacement were recorded and evaluated. The minimum follow-up was one year. Results All cases achieved radiographic union by 15 weeks postoperatively except one from the hybrid fixation cohort. The average time to radiographic union was comparable (p=0.30). Twenty-two point two percent (22.2%; 2 out of 9) of the cases from each cohort had an increase in the fracture gap (>2 mm) at around four to six weeks postoperatively, for which all except one case from the hybrid fixation cohort achieved union thereafter. One patient from the hybrid fixation cohort had fibrous non-union and further fracture displacement. There was another case of mild fracture gapping and screw breakage on review of postoperative radiographs at three months from the hybrid fixation cohort. These patients recovered without surgical revision or implant removal. Conclusions Both non-metal fixation methods for mid-pole transverse patellar fractures proved to be radiographically and functionally comparable.