Age-related differences in surgically treated patellar fractures: associations with fracture pattern, treatment strategy, and clinical outcome

Abstract Background Patellar fractures are clinically significant due to their impact on the knee's extensor system. Displaced fractures usually require surgical treatment, and two biomechanically different fixation methods are accepted alternatives (tension-band wire cerclage (CCW) and angle-stable plate fixation (LP)). The aim of the study was to investigate age-related differences in fracture complexity, treatment and outcome. We hypothesized that older patients sustain more complex fractures, possibly associated with longer operative times than younger patients. Methods This is a retrospective cohort study at the University Hospital of Zurich. Patient data were collected from January 2013 to March 2023. A total of 63 patients were included: patients ≥18 years of age who underwent either CCW or LP. The injury characteristics, treatment and outcomes of older (≥ 55 years) and younger patients (< 55 years) were compared. The follow-up period was minimum 1 year after injury. We compared patient and fracture characteristics as well as outcome. Results 63 patients (35 young, 28 older) were analyzed. Younger patients had statistically significant higher number of fracture fragments (4.0 ± 1.8 versus 3.5 ± 1.5 fragments, p =0.02). Higher reoperations (n=11 versus n=2, p=0 .0015) and re-osteosynthesis rates (n=6 versus n=0, p= 0.0055 were also found in younger patients compared to the elderly. Conclusion This study reconfirms that younger patients suffer more high-energy injuries and more complex patellar fractures compared to older patients. These were associated with had longer surgery times, possibly due to efforts for optimal reduction and fixation. They also required more re-interventions, suggesting that rehabilitation protocols might have to be reinforced in this particular high risk group.