Locking plates beat tension-band wiring for displaced patellar fractures

The edition in brief

Tension-band wiring for patellar fractures has persisted despite well-known complication rates, largely because nothing better had been tested properly. This patient- and assessor-blinded multicentre trial randomised 122 adults with displaced patellar fractures to locking plate fixation or tension-band wiring, with superiority predefined as significant differences exceeding the minimal clinically important difference on at least three KOOS sub-scales at twelve months. Locking plates achieved exactly that, on symptoms (mean difference 10.4 points), sport and recreation (14.1) and quality of life (10.9). Hardware removal, fixation failure and reoperation were all more frequent after wiring. A separate randomised trial compared conventional jig-based with robotic arm-assisted unicompartmental knee arthroplasty in 107 patients with medial compartment osteoarthritis. Robotic assistance improved accuracy of femoral and tibial component positioning, reduced inpatient pain and opioid use, and shortened hospital stay. But Oxford Knee Score, KOOS and WOMAC were no different at two years; only the Forgotten Joint Score favoured the robot. Recruitment declined during the trial as patients and surgeons lost equipoise. A meta-analysis of 13 trials and 1,176 patients found perioperative duloxetine reduced pain after hip and knee arthroplasty by about 5 mm on a 100 mm scale — statistically significant but below the usual clinical threshold — with opioid sparing at 48 and 72 hours and more drowsiness. A dose-response review of resistance exercise in knee osteoarthritis found the greatest estimated functional gains at around 2,600 repetitions of moderate-intensity training.