Fixation of patella fracture with non-metallic implant

Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group ( p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group ( p < 0.003). All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well.