Title : Fixed angle locking plate in patellar fractures: A prospective evaluation of functional and radiological outcomes
Abstract:
Background: Patellar fractures account for approximately 1% of all skeletal injuries and can significantly disrupt the extensor mechanism of the knee. Traditional fixation methods such as tension band wiring (TBW) are often associated with complications including hardware irritation, fixation failure, and impaired knee function. Fixed angle locking plates have emerged as a promising alternative, particularly for comminuted and osteoporotic fractures, offering enhanced stability and allowing early mobilisation.
Methods: A prospective study was conducted over 18 months at a tertiary care centre. Twenty-five patients aged over 20 years with displaced or comminuted patellar fractures underwent open reduction and internal fixation (ORIF) with fixed angle locking plates. Patients were evaluated at 3 weeks, 6 weeks, 3 months, and 6 months postoperatively. Clinical outcomes were assessed using the Knee Outcome Survey – Activities of Daily Living (KOS-ADL) score, active knee flexion measurements, and radiographic union.
Results: The mean KOS-ADL score improved significantly from 11.56 preoperatively to 63.46 at 24 weeks (p<0.001). Mean knee flexion increased from 67.28° at 4 weeks to 122.71° at 24 weeks. Radiological union was achieved in 92% of patients by 24 weeks. The complication rate was low (16.8%), including one non-union with implant failure, one superficial surgical site infection, and two cases of anterior knee pain. A significant positive correlation was observed between knee flexion and KOS-ADL score (r = 0.60, p = 0.002), while delay in surgical intervention negatively affected outcomes (r = –0.44, p = 0.02).
Conclusion: Fixed angle locking plates offer stable fixation, facilitate early mobilisation, and achieve excellent functional and radiological outcomes in the management of patellar fractures. This technique presents a reliable alternative to traditional fixation methods, particularly in complex or comminuted fractures, with a favourable recovery profile and lower complication rates.
Disclosure: The authors declare no conflicts of interest.
