Locking plates beat tension-band wiring for displaced patellar fractures

The edition in brief

A patient- and assessor-blinded multicentre trial randomised 122 adults with displaced patellar fractures to locking plate fixation or tension-band wiring. At 12 months, plating improved three KOOS sub-scales by clinically meaningful margins — symptoms 10.4 points, sport and recreation 14.1, quality of life 10.9 — and hardware removal, fixation failure and reoperation were more common after wiring. An interim report of 107 patients randomised to robotic arm-assisted or jig-based medial unicompartmental knee arthroplasty found more accurate component positioning, less inpatient pain and opioid use and shorter stay with the robot, and a better Forgotten Joint Score, but no difference in Oxford, KOOS or WOMAC scores at two years. Linked UK primary and hospital data on 476,620 knee, hip and shoulder arthroplasties found six-month VTE of 1.5%, with over 30% of events visible only in the linked data; rates fell over time, but NICE guideline changes were not associated with a step change for hips and knees. A Cochrane review of 17 trials in men aged 50 and over was very uncertain whether bisphosphonates, anabolic agents, denosumab or romosozumab reduce fractures, because trials were small, short and had few events.