Vertical Cerclage Wiring Provides Superior Early Postoperative Alignment in Inferior Pole Patellar Fractures Compared to Tension Band Wire and Transosseous Suture: A Preliminary Retrospective Radiographic Analysis

Abstract Background: Inferior pole patellar fractures are challenging to treat due to fragment comminution and high extensor mechanism forces, which complicate both reduction and maintenance of fixation. While traditional methods such as tension band wiring (TBW) and suture repair (SR) are commonly used, novel techniques such as vertical cerclage wiring (VCW) have been introduced to improve fixation strength and facilitate early rehabilitation. However, comparative studies evaluating early postoperative alignment among these methods are lacking. Objectives: This study aimed to compare early postoperative alignment outcomes among three fixation techniques – VCW, TBW, and SR – for inferior pole patellar fractures, using a novel radiographic measurement method. Materials and Methods: A retrospective review was conducted of 36 patients with AO/OTA 34 A1 extra-articular inferior pole patellar fractures treated between April 2016 and May 2025. Patients were grouped by fixation method: VCW ( n = 7), TBW ( n = 14), and SR ( n = 15). Postoperative alignment was assessed on lateral radiographs using three parameters: residual gap, fracture apposition, and angulation. Statistical analysis included the Kruskal–Wallis test and post hoc Dunn’s test. Results: There were no significant differences in demographic or preoperative fracture characteristics among the three groups. The VCW group showed a significantly smaller residual gap compared to the SR group and significantly less fracture angulation than both the TBW and SR groups. No significant differences in fracture apposition were observed among the groups. Conclusions: VCW provides superior early postoperative alignment in inferior pole patellar fractures, with significantly less residual gap and angulation compared to TBW and SR. These findings support VCW as a biomechanically favorable option for comminuted inferior pole patellar fractures, although further studies with larger cohorts and longer follow-up are warranted to assess long-term outcomes.