Incidence of Implant Removal in Surgically Treated Patella Fractures

Context: Patella fracture is frequently encountered in day to day practice of every orthopedic surgeon, yet conventional modalities of fixation that are associated with a high incidence of implant removal continue to be standard practice. Aim: To estimate the incidence of implant removal in surgically managed patella fractures. Settings and design: Retrospective study. Materials and methods: Data of surgically managed patella fractures in our institution from January 2017 to December 2019 was collected from the hospital management system and analyzed retrospectively. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA) was used for the analysis of data. Nominal and categorical variables were analyzed using Chi-square, and continuous data were expressed as mean and standard deviation. A p-value ≤0.05 was considered significant. Results: The study group had a total of 106 patients, with 74 males and 32 females and an average age of 47.67 ± 17.85 years. Most commonly the fractures occurred following an accidental fall and road traffic accident. A comminuted pattern was most common. The mean length of stay was 7.34 ± 4.21 days. Osteosynthesis with Kirschner wire and tension band wires was done in 83 cases. The average follow-up was 13 months (range, three to 48 months). Twenty-two patients (one in five) required a second surgery for implant removal and the rate was higher in patients more than 60 years of age, females, and comminuted fractures. Cases managed with cannulated cancellous screws did not require any removal. The average timing of removal was 14 months (range, seven to 28 months). Relief of symptoms following removal was observed in 86% of cases. Conclusion: Conventional fixation techniques offer good union rates but at a cost of a high incidence of removal. Multi-centric trials are required to compare the rates of removal of conventional methods with new techniques being adopted.