No difference in outcomes between open, closed reduction for patellar fractures
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Closed reduction compared with open reduction may not be an inferior surgical treatment for patellar fractures as researchers found no significant differences seen between the treatments with regard to outcomes.
Researchers retrospectively reviewed data for 62 patients who underwent surgical treatment of patellar fractures between 2008 and 2013. There were 42 open reductions and 21 closed reductions performed. Fracture healing was assessed with plain radiography.
Results showed the most common fracture type in both groups was a comminuted patellar fracture. Investigators noted tension band wiring was used in the open reduction group and cannulated screw fixation was used in the closed reduction group. The two groups were not significantly different with regard to modified Hospital for Special Surgery score, VAS score for pain and range of motion. The mean time to union was 3.2 months for patients who underwent open reduction and was 3 months for patients who underwent closed reduction. In the open reduction group, there were five cases with postoperative knee stiffness. There were three cases of this in the closed reduction group. A re-fracture was seen in one patient who underwent open reduction. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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John P. Fulkerson, MD
The results of this study are a little surprising to me as I have always favored a rigorous attempt to restore the patella articular surface in surgical treatment of patella fractures. The truth is, though, that patients don't always do so well after commented patella fractures, despite the best of efforts.
My concern with the findings of this study is that some surgeons might pay less attention to articular restoration in these serious, life-changing injuries to the patella.
Perhaps the best way to process the Lee study is to be realistic in treating comminuted patella fractures. I do believe; however, that we must not relax and ignore the potential life-changing consequences of patella fractures and, at least, make a reasonable effort to optimize the joint by articular restoration.
Hartford, Connecticut
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