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Comparative Study
. 2025 May 22;20(1):497.
doi: 10.1186/s13018-025-05899-6.

Separate vertical wiring versus conventional tension band fixation for inferior pole patellar fractures: a prospective cohort study on postoperative patella baja and functional outcomes

Yanchun Gao  1 , Shichang Zhao  1 , Xingang Yu  2 , Yun Qian  3 , Dehao Fu  4
Affiliations
Comparative Study

Separate vertical wiring versus conventional tension band fixation for inferior pole patellar fractures: a prospective cohort study on postoperative patella baja and functional outcomes

Yanchun Gao et al. J Orthop Surg Res. .

Abstract

Objective: To compare the clinical efficacy of the separate vertical wiring (SVW) technique and conventional tension band fixation in managing AO/OTA type A1 inferior pole patellar fractures, focusing on postoperative patella baja incidence and functional recovery.

Methods: From January 2019 to January 2023, 242 patients with AO/OTA A1 inferior pole patellar fractures undergoing surgical treatment were assigned to the SVW group (n = 117) or tension band (TB) group (n = 125). The primary outcome was the incidence of patella baja (Insall-Salvati index < 0.8) at the 12-month follow-up. Secondary outcomes included knee range of motion (ROM), Böstman functional score, and complications.

Results: The SVW group demonstrated a significantly lower incidence of patella baja compared to the TB group (25.6% vs. 52.1%, P < 0.001), with higher mean (Insall-Salvati index) ISI values (0.87 ± 0.16 vs. 0.76 ± 0.12, P < 0.01). Knee ROM was superior in the SVW group (124.0°±14.2° vs. 119.9°±12.4°, P = 0.017), though no significant difference was observed in Böstman scores (25.1 ± 3.5 vs. 24.6 ± 3.6, P = 0.33). The overall complication rate was 5.8% (14/242), primarily comprising surgical site infections (3.5%, 8/242: 1.2% superficial, 2.1% deep), fixation failure (1.2%, 3/242), and nonunion (0.8%, 2/242). Notably, soft tissue irritation occurred exclusively in the TB group (8.8%, 11/125 vs. 0% in SVW; P = 0.005).

Conclusion: The SVW technique significantly reduces the risk of patella baja and improves knee range of motion by optimizing vertical tension distribution, establishing it as a biomechanically superior fixation strategy for AO/OTA A1 inferior pole patellar fractures. These findings support SVW as a first-line treatment for such complex injuries.

Keywords: Conventional tension band; Functional outcomes; Inferior pole patellar fracture; Patella Baja; Separate vertical wiring.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Shanghai Sixth people’s hospital. Informed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided informed consent for the publication of the images. Consent to participate: Informed consent was obtained from all individual participants by phone call. Consent to publish: All authors have agreed to the publication of the article. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient Enrollment Flow Diagram
Fig. 2
Fig. 2
A 54-year-old male patient with an inferior pole patellar fracture treated using the SVW technique. Postoperative anterior-posterior and lateral knee radiographs demonstrate stable fixation of the fracture fragment through SVW technique
Fig. 3
Fig. 3
A the treatment of inferior pole fracture of the patella with the modified separate vertical wire technique. B The treatment of inferior pole fracture of the patella with the tension band combined with cerclage wire
See this image and copyright information in PMC

References

    1. Allen C, Jin LM. Fracture of the inferior pole of the patella. J Orthop Sports Phys Ther. 2012;42(7):658. - DOI - PubMed
    1. Misir A, Kizkapan TB, Uzun E, Oguzkaya S, Cukurlu M, Golgelioglu F. Fracture patterns and comminution zones in OTA/AO 34 C type patellar fractures. J Orthop Trauma. 2020;34(5):e159–64. - DOI - PubMed
    1. Saltzman CL, Goulet JA, McClellan RT, Schneider LA, Matthews LS. Results of treatment of displaced patellar fractures by partial patellectomy. J Bone Joint Surg Am. 1990;72(9):1279–85. - DOI - PubMed
    1. Neumann-Langen MV, Sontheimer V, Nascher J, Izadpanah K, Schmal H, Kubosch EJ. Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study. BMC Musculoskelet Disord. 2023;24(1):871. - DOI - PMC - PubMed
    1. Zhu W, Xu L, Xie K, et al. Design and validation of a Smile-Necklace plate for treating inferior patellar pole avulsion fractures: A review and hypothesis. Orthop Surg. 2022;14(11):2799–808. - DOI - PMC - PubMed

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