Design: Multicentre randomised trial, patient- and assessor-blinded
Population: 122 adults with displaced patellar fractures
Primary outcome: KOOS sub-scales at 12 months
Effect: Symptoms +10.4 (4.4 to 16.4); sport +14.1 (3.4 to 24.7); QoL +10.9 (2.7 to 19.0)

In this patient- and assessor-blinded multicentre trial in Denmark, 122 adults with displaced patellar fractures were randomised to locking plate fixation (63) or tension-band wiring (59). Superiority was defined in advance as a clinically meaningful difference in at least three of five KOOS sub-scales at 12 months.

Plating met that bar: symptoms improved by 10.4 points (95% CI 4.4 to 16.4), sport and recreation by 14.1 (3.4 to 24.7) and quality of life by 10.9 (2.7 to 19.0). Hardware removal, fixation failure and reoperation were more frequent after wiring. Follow-up was about 90% in both arms.

Tension-band wiring is cheap and familiar, but its prominent hardware is the reason many patients return to theatre. This trial gives the first high-level evidence that plating is better from the patient's perspective. Implant cost and availability will matter in Indian practice.

Consider locking plate fixation as the default for displaced patellar fractures needing surgery.
Warn patients having tension-band wiring that hardware removal is common.
Plan fixation on CT where comminution is suspected.
Weigh implant cost against the lower reoperation rate when choosing.

Why it matters

It overturns the default use of tension-band wiring with randomised, blinded evidence.

The statistics, in plain English

Each of the three sub-scale gains exceeds the predefined minimal clinically important difference of 9 to 10 points. The lower ends of the intervals are smaller, so the true benefit could be modest. The two other sub-scales (pain and daily living) did not meet the threshold.