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Researchers find 34% reoperation rate after patella fracture fixation

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A meta-analysis conducted by researchers at Hospital for Special Surgery in New York reveals a high reoperation rate, but low rates of infection and nonunion among patients who underwent open reduction and internal fixation for patella fracture.

"Our meta-analysis of 737 fractures in 24 studies has shown that approximately one-third of patients undergo reoperation after patella fixation, but nonunion rates are relatively low at 2%," Christopher J. Dy, MD, MSPH, said. "Our data suggests that we need to study ways that we can decrease this relatively high reoperation rate without lowering our successful nonunion rates. Epidemiologic data and our experience in New York suggest that the incidence of patella fractures is rising, especially in older osteoporotic patients. The morbidity, risk of refracture and cost associated with reoperation in this patient population cannot be underestimated, further suggesting that we strive for fixation techniques and strategies to meet this challenge."

Dy and colleagues Milton TM Little, MD; Marschall B. Berkes, MD; Yan Ma, PhD; Timothy Roberts, MLS; Dean G. Lorich, MD; and David L. Helfet, MD, searched PubMed, Embase and the Cochrane database for studies published between 1978 and 2011 with at least 12-months follow-up on patients who had patella fracture fixation and included information about reoperations, nonunions and infections. They excluded case reports, technique descriptions and cadaveric and biomechanical studies. They also excluded studies that involved periprosthetic fractures, osteochondral lesions, or existing malunions or nonunions. The researchers determined pooled data rates for each complication and used random effects regression modeling to control for covariates and study heterogeneity.

The regression analysis identified no predictors of reoperation, infection or nonunion when the investigators examined for age, gender, technique and date of publication, Dy said.

"We have shown a 34% reoperation rate for all causes after patella open reduction and internal fixation, an infection rate of 3% and a nonunion rate of 2%,” Dy said. “There were no detectable predictors for complications among the variables that were examined. The findings are limited by the lack of consistent reporting of reasons for reoperation and fracture classification, as well as the change of variations of rehabilitation protocols as well as the lack of patient-centered outcomes."

Reference:

Dy CJ. Have outcomes after patella fracture fixation improved in the last 33 years? A systematic review and meta-analysis. Presented at: the 13th EFORT Congress; May 23-25, 2012; Berlin.

Disclosure: Dy has no relevant financial disclosures.