Influence of Weight-Bearing Status After Tension Band Wiring of Patellar Fractures in Elderly Patients

Background Patellar fractures can severely affect mobility in the elderly, particularly due to compromised bone quality. Tension band wiring (TBW) is commonly used to repair displaced transverse fractures and permits early mobilization; however, the optimal timing for weight-bearing in elderly patients has not been clearly established. This study evaluated the outcomes of immediate versus delayed weight-bearing following TBW. Methods A retrospective cohort study was conducted involving elderly patients (≥60 years) from two hospitals in London. Patients were categorized into immediate (Day 0 post-op, n = 14) and delayed (>Day 0 post-op, n = 10) weight-bearing groups. Primary outcomes included knee range of motion (ROM), degree of extensor lag, reoperation rate, and time to union. Secondary outcomes included loss of fixation, implant failure, time to initiate knee flexion, and adherence to the rehabilitation protocol. Results Overall, patients in the immediate weight-bearing (IWB) group achieved union faster (8.4 weeks versus 13.7 weeks; p = 0.01), experienced less loss of reduction (n = 0, 0% versus n = 3, 30%; p = 0.03), had greater knee ROM (120.5° versus 101.3°; p = 0.02), and initiated knee flexion sooner (6.0 weeks versus 7.2 weeks; p < 0.001). There were no statistically significant differences between groups in extensor lag, need for reoperation, implant failure, or adherence to rehabilitation. Conclusions IWB after TBW of patellar fractures in elderly patients promotes fracture healing, knee function, and stability compared to traditional non-weight-bearing protocols and does not increase complication rates, supporting early mobilization strategies. Multicenter prospective studies with standardized fracture patterns are required to confirm these findings.