Comparing all-suture repair versus tension band wiring fixation in patellar fractures

Implant-related issues necessitating removal are well reported in tension band wiring (TBW) of patellar fractures. Suture materials can minimize complications associated with TBW fixation but there is a paucity of literature on all-suture fixation outcomes. This study aims to compare outcomes between all-suture versus TBW fixation of patellar fractures. This retrospective, single-centre study included 79 patients with patellar fractures that underwent fixation with either all-suture (n = 49) or TBW (n = 30) fixation from 2020 to 2023, regardless of demographic or fracture characteristics. Outcomes reported include intra-operative duration, length of stay, bony union rate and time, post-operative knee range of motion, complications, and re-operation rate. Mean age in years was 63.5 ± 11.9 and 65.2 ± 12.9 in the all-suture and TBW groups respectively. Bony union time in months was comparable between the all-suture group (4 ± 1.58) and TBW group (4.37 ± 1.81) (p = 0.34). Union rate was comparable between all-suture (98%) and TBW groups (100%). Complication rate was lower in the all-suture group (4.1%) when compared to the TBW group (13.3%) (p = 0.19). 10% of TBW group patients underwent re-surgery due to implant-related complications compared to 0 cases of re-surgery in the all-suture group (p = 0.05). More patients in the TBW group (23.3%) experienced flexion contracture as compared to the all-suture group (2%) (p = 0.004), and with a greater degree of contracture of 2.1° ± 4.6 vs. 0.2 ± 1.4 (p = 0.002). The all-suture group had a higher prevalence of post-operative patellar baja (67.3%) (p = 0.002). However, this was found to have no significant impact on the presence of knee contracture after subgroup analysis (p = 1.00). No significant differences were seen in operative duration, length of stay and post-operative knee flexion between the two groups (p > 0.05). All-suture fixation of patellar fractures is a reliable surgical method with a high union rate, good union time and post-operative range of motion, while avoiding implant-related complications that may result in re-operation. It is a safe alternative surgical technique in fixation of patellar fractures.