The edition · Orthopaedics
Locking plate fixation beat tension-band wiring for displaced patellar fractures on every measure that matters
A multicentre randomised trial of 122 patients found plate fixation gave clinically meaningful gains across three KOOS subscales at twelve months, with less hardware removal, less fixation failure and fewer reoperations. Separately, robotic unicompartmental knee arthroplasty lost equipoise mid-trial as surgeons and patients stopped accepting randomisation.
The edition in brief
The clearest practice signal today is a straightforward surgical comparison. A multicentre randomised trial assigned 122 patients with displaced patellar fractures to locking plate fixation or tension-band wiring, with about 90% completing twelve-month follow-up. Plate fixation produced statistically significant and clinically meaningful improvements in three KOOS subscales — symptoms, sport and recreation, and quality of life — and hardware removal, fixation failure and reoperation were all more frequent after tension-band wiring. Tension-band wiring has been the default for decades on grounds of cost and familiarity; this is high-level evidence against it. The robotic unicompartmental knee trial is interesting as much for what happened to it as for its results. Robotic assistance improved component positioning accuracy, reduced inpatient pain and opioid use, shortened stay, and improved Forgotten Joint Score at six months and two years — but the Oxford Knee Score, KOOS and WOMAC showed no difference at two years. Recruitment then declined as patients increasingly requested the robotic arm and surgeons lost equipoise, which is a methodological problem and a finding in itself. A dose-response meta-analysis of 20 trials in knee osteoarthritis located the peaks: greatest pain reduction around 6,000 repetitions, best function around 2,600 at moderate intensity, maximal strength around 1,600 — on low to very low certainty evidence.
Plate fixation outperformed tension-band wiring for displaced patellar fractures
For displaced patellar fractures, locking plate fixation gave clinically meaningful improvements in symptoms, sport and quality of life at twelve months, with less hardware removal, fixation failure and reoperation than tension-band wiring.
Robotic unicompartmental knee arthroplasty improved early recovery, and the trial lost equipoise
Robotic unicompartmental knee arthroplasty improved component accuracy, early pain, opioid use and length of stay, without differences in Oxford Knee Score, KOOS or WOMAC at two years.
The dose-response curve for resistance exercise in knee osteoarthritis has peaks
Resistance training in knee osteoarthritis showed non-linear dose-response with pain, function and strength peaking at different volumes — around 6,000, 2,600 and 1,600 repetitions respectively.
No new regulatory action; vitamin D and stress fracture, with a subgroup that inverts the message
Lower vitamin D was associated with stress fractures in military personnel and men, but only in populations where controls were already vitamin D sufficient — and this is association, not evidence for supplementation.
When a trial loses equipoise, note who stopped accepting randomisation
When a trial reports interim results because equipoise was lost, ask whether the belief that ended it came from the data or from outside — the latter makes the result weaker than its statistics suggest.
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