Early complications associated with fixation constructs of operatively treated patella fractures: a retrospective study

Although multiple fixation constructs exist for patella fractures, postoperative complications are common, and optimal construct choice remains unclear. This study evaluated construct-specific complication rates in operatively treated patella fractures. A retrospective review was conducted of adult patients who underwent surgical fixation of patella fractures (AO/OTA 34) at a Level I trauma center between 2012 and 2022. Patients younger than 18 years, treated with isolated cerclage wiring, or with less than 90 days of follow-up were excluded. Patients were stratified by fixation construct: tension band wiring (TBW), plate, screws, tendon advancement, or multiple constructs. Demographic, injury, and clinical data were obtained from medical records. Primary outcomes included reoperation, fixation failure, nonunion, deep infection, and SIR. A total of 242 patients were included and stratified by construct type: TBW (n = 106), plate (n = 18), screws (n = 39), TA (n = 60), and multiple constructs (n = 19). Patients treated with plates were significantly younger (37.1 vs. 45.8 years; p = 0.023) and more likely to have open fractures (50.0%; p = 0.025), comminuted fracture patterns (≥ 4 fragments: 83.3%; p < 0.001), and OTA 34C3 fractures (77.8%; p < 0.001). Plate fixation was associated with a higher rate of SIR compared to other groups (27.8%; p = 0.012), while no significant differences were observed in reoperation (p = 0.142), nonunion (p = 0.652), fixation failure (p = 0.316), or infection (p = 0.505). In subgroup analysis, suture cerclage augmentation in TBW was associated with significantly higher rates of reoperation (85.7% vs. 19.2%; p < 0.001), nonunion (57.1% vs. 8.1%; p = 0.003), and fixation failure (57.1% vs. 15.2%; p = 0.019). Plate fixation was associated with higher SIR, and suture cerclage in TBW constructs was associated with increased complications in patella fracture fixation.