Developments in the epidemiology and surgical management of patella fractures in Germany

Abstract

Background: Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database.

Methods: Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends.

Results: A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period.

Conclusions: We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.

Keywords: Epidemiology; Incidence; Knee; Patella fracture; Plate osteosynthesis; Technology diffusion.

Fig. 1

a-f: patella fracture with involvement of the inferior pole, overlooked in initial radiography but diagnosed in a preoperative CT (a—d). Postoperative X-ray shows an anatomic reduction with a locked hook plate and compression screws (e–f)

Fig. 2 a

and b: Documented annual surgical treatments and occurrence of patellar fractures over 15 years in Germany

Fig. 3

Age distribution of patellar fractures and associated surgery per 100,000 capita per year

Fig. 4 a

and b: Surgery incidence per 100,000 capita per year among male and female patients

Fig. 5

Increase in complex fracture types over time; the percentage of complex fractures is overlaid with values on the right y-axis

Fig. 6

The share of plate osteosynthesis in all patellar fracture types over time

Fig. 7

Plate Osteosynthesis in complex and simple fractures