The edition · Orthopaedics
Locking plates beat tension-band wiring for displaced patellar fractures in a blinded trial
A multicentre randomised trial found better symptoms, sport and quality of life at a year, and fewer reoperations, with plate fixation. Plus double-row cuff repair by tear size, robotic versus jig-based unicompartmental knees, and what linked records reveal about clots after arthroplasty.
The edition in brief
In a patient- and assessor-blinded multicentre trial, 122 adults with displaced patellar fractures were randomised to locking plate fixation or tension-band wiring. At 12 months, plate fixation met its predefined test of superiority, improving three of five KOOS sub-scales by more than the minimal important difference: symptoms (10.4 points), sport and recreation (14.1) and quality of life (10.9). Hardware removal, fixation failure and reoperation were more common after wiring. A meta-analysis of 18 randomised trials (1,308 patients) found double-row rotator cuff repair lowered retear rates and improved function overall, but the advantage was confined to tears of 30 mm or more; for smaller tears single-row repair gave similar results in less time. An interim report from a double-blinded trial of 107 patients found robotic arm-assisted medial unicompartmental knee replacement placed components more accurately and reduced early pain, opioid use and stay, with no difference in Oxford, KOOS or WOMAC scores at two years. A linked primary and hospital care study of 476,620 UK arthroplasties found six-month venous thromboembolism in 1.5%, with more than 30% of events found only through primary care or death records. The pearl covers the extensor mechanism check in every patellar fracture.
Double-row cuff repair paid off for tears of 30 mm or more, not for smaller ones
Use double-row repair for rotator cuff tears of 30 mm or more; for smaller tears, single-row gives similar results faster.
Robotic unicompartmental knees were more accurate and recovered faster, but scored the same at two years
Robotic unicompartmental knee replacement improved accuracy and early recovery; two-year function scores were the same.
Hospital data alone missed almost a third of clots after joint replacement
About 15 in 1,000 joint replacements was followed by a clot within six months, and hospital records alone missed many.
In every patellar fracture, test the extensor mechanism
Test the extensor mechanism in every patellar fracture before deciding on surgery.
Locking plates gave better knees than tension-band wiring for displaced patellar fractures
For displaced patellar fractures, consider locking plate fixation over tension-band wiring where implants are available.
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