Clinical and functional outcomes of locking plate versus cerclage compression wiring for comminuted patella fracture fixation

Background: Comminuted patella fractures (AO Foundation type 34-C3) are complex and challenging to treat. Cerclage compression wiring (CCW) has been the standard fixation method, but recent advancements in locking plate (LP) fixation offer biomechanical advantages. This study compares the clinical and functional outcomes of LP versus CCW for AO type 34-C3 patella fractures in a local district hospital in Hong Kong. Methods: This retrospective cohort study included 30 adults (aged ≥18 years) with AO type 34-C3 patella fractures treated with LP ( n = 14) or CCW ( n = 16) between January 2023 and January 2025. Primary outcomes were complication and reoperation rates. Secondary outcomes included length of stay, Tegner Activity Scale and Lysholm functional scores, and range of motion at 6 months postoperation. Demographic and procedural data were analysed. Statistical significance was set at p < 0.05. Results: The LP group showed significantly lower complication rates (14.3% vs. 56.3%, p = 0.017), mainly due to fewer implant-related issues. Postoperative Tegner Activity Scale scores were higher in the LP group (median: 4 vs. 3, p = 0.013). Reoperation rates ( p = 0.337), length of stay ( p = 0.662), Lysholm functional scores ( p = 0.364), and range of motion at 6 months postoperation ( p = 0.294) showed no significant differences. No wound complications were reported. LP fixation required longer operative times (140.9 vs. 102.9 min, p = 0.002). Conclusion: This study provides consistent evidence that LP fixation is superior to CCW for AO Foundation type 34-C3 patella fractures, particularly in Asian populations, with lower complication rates and better functional outcomes. Despite a small sample size ( n = 30) and single-centre design, these findings support adopting LP fixation.