A multicentre randomised controlled trial assigned 63 patients to locking plate fixation and 59 to tension-band wiring for displaced patellar fracture. Follow-up at twelve months was completed by 90.5% and 88.1% respectively.
Plate fixation produced statistically significant and clinically meaningful improvements across three KOOS subscales: symptoms (mean difference -10.4, interval -16.4 to -4.4), sport and recreation (-14.1, -24.7 to -3.4), and quality of life (-10.9, -19.0 to -2.7). Hardware removal, fixation failure and reoperation were all more frequent after tension-band wiring.
Tension-band wiring has been the default for displaced patellar fractures for decades, on grounds of cost, simplicity and familiarity rather than comparative evidence. Its well-known failure mode is exactly what this trial measured: prominent hardware causing symptoms that lead to a second operation for removal. That is not a minor complication when it happens to a substantial fraction of patients.
The implant cost difference is real and this trial does not address it. But a technique that produces better patient-reported outcomes and fewer reoperations changes where the burden of justification sits.
- 122 patients, multicentre, with about 90% follow-up at twelve months
- Three of the KOOS subscales moved by clinically meaningful margins
- Hardware removal, fixation failure and reoperation all favoured plating
- Cost and implant availability are not addressed and remain real constraints
- Twelve-month follow-up; longer-term function is still unreported
The statistics, in plain English
The KOOS differences are reported with intervals that exclude zero and, importantly, the authors describe them as clinically meaningful rather than only statistically significant — meaning the effect exceeds the smallest difference patients notice on that scale. With 122 patients the reoperation comparison is less precisely estimated than the KOOS scores, so treat the direction as established and the magnitude as approximate.
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