Changes in patellar fracture characteristics: A multicenter retrospective analysis of 1596 patellar fracture cases between 2003 and 2017

Abstract

Purpose: This study aimed to investigate the characteristics of patellar fracture and the changes in these characteristics over time in Korea.

Methods: A total of 1596 patients with patellar fractures who visited 5 university hospitals from 2003 to 2017 were included in the analysis. The demographic characteristics of the patients, including age, sex, body mass index, and fracture characteristics, including the fracture classification, injury mechanism, fixation method, and postoperative complication rate, were analyzed through a review of the medical records and plain radiographs.

Results: There were 988 (61.9%) male patients and 608 (38.1%) female patients. The mean age was 51.3 (range, 3-97) years for the study group, 47.6 (range, 8-94) years for male patients, and 57.3 (range, 3-97) years for female patients. Increasing trends in the proportion of patients aged ≥60 years and in the proportion of female patients were observed during the study period (p = 0.002 and p < 0.001, respectively). The fixation method also changed significantly during the study period, with decrease of the tension band wiring and increase of the combined method (p < 0.001). The incidence of high-energy injuries and more complex types of fracture was higher in male patients than in female patients (p < 0.001 and p < 0.001, respectively). Patients aged ≥60 years with patellar fractures showed a higher percentage of low-energy injuries and higher postoperative complication rates than younger patients (p < 0.001 and p = 0.002, respectively).

Conclusions: Patellar fractures in the female and elderly populations are increasing. Moreover, elderly patients with patellar fractures had a higher postoperative complication rate and also a higher percentage of low-energy injury than younger patients. Therefore, patellar fractures in the elderly population should be considered fragility fractures, and further studies are warranted to suggest a specific treatment plan for fragility patellar fractures.

Keywords: Classification; Fixation method; Fragility fracture; Patella; Patellar fracture.