{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:26:05Z","timestamp":1793132765739,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To compare the outcomes of comminuted patella fractures fixed with a new patella-specific 2.7-mm variable-angle (VA) locking plate in isolation versus when augmentation of fracture fixation is applied with the plate.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Academic Level I Trauma Center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n All acute comminuted patella fractures (AO\/OTA 34-C3; complete displaced or undisplaced articular, frontal\/coronal multifragmentary fractures) in adult patients primarily treated with a new patella-specific 2.7-mm VA locking plate (Synthes, Paoli, PA) between January 2021 and February 2024 at a single academic center were reviewed and divided into those fixed with the patella plate alone and those with additional bony and\/or soft-tissue augmentation. Excluded were those with <90 follow-ups, set a priori, unless complications occurred <90 days.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n Comparison of patient age, sex, body mass index, American Society of Anesthesiologists score, fracture risk (FRAX) score, open fracture, polytrauma involvement, length of follow-up, and postoperative protocols was made between groups. The primary outcome measure was loss of fixation. Secondary outcomes included mode of failure and other surgical complications.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n There were a total of 38 included patients, with no lack of or loss of follow-up, with 20 grouped into patella plate alone and 18 into patella plate plus augmentation. The plate-only group had a higher mean age (63.7 vs. 46.9,\n P<\/jats:italic>\n = 0.024), with no between-group differences in sex (65% vs. 44% women,\n P<\/jats:italic>\n = 0.20), body mass index (\n P<\/jats:italic>\n = 0.51), 10-year FRAX (\n P<\/jats:italic>\n = 0.06), open fractures (\n P<\/jats:italic>\n = 0.30), polytrauma involvement (\n P<\/jats:italic>\n = 0.97), or postoperative weight-bearing (\n P<\/jats:italic>\n = 0.76) or range of motion (\n P<\/jats:italic>\n = 0.06) protocols. There were 8 failures (40.0%) in the plate-only group and 2 failures in the plate with augmentation group (11.1%;\n P<\/jats:italic>\n = 0.043). When controlling for known risk factors for osteoporosis and poor bone quality using the FRAX 10-year fracture risk on multivariable regression analysis, plate fixation with fracture augmentation was associated with a lower risk of fixation failure (odds ratio = 0.14, 95% CI 0.02\u20130.75;\n P<\/jats:italic>\n = 0.036). The plate-only group failed by loss of distal (62.5%, n = 5) and proximal fixation (37.5%, n = 3). Each of the 2 failures in the plate plus augmentation group had a loss of distal fixation.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Treatment of comminuted patella fractures with a new patella-specific 2.7-mm VA locking plate had a high failure rate when used in isolation. Augmenting fracture fixation with soft-tissue repair and\/or independent fracture fragment fixation may significantly decrease failure rates. In particular, augmentation of the tendon avulsion component to restore the extensor mechanism appears critical.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000002972","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T09:02:29Z","timestamp":1741338149000},"page":"320-330","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["High Failure Rates in Comminuted Patella Fractures (AO\/OTA 34-C3) Fixed With an Isolated, New Patella-Specific 2.7-mm Variable-Angle Locking Plate"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-3065","authenticated-orcid":false,"given":"Wayne","family":"Hoskins","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"},{"name":"University of Melbourne, Melbourne, Australian."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rown","family":"Parola","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Gusho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime L.","family":"Bellamy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulai","family":"Bangura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Schweser","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"DeFroda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Crist","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Haase","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250516","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/2151458517710517","article-title":"Comminuted patella fracture in elderly patients: a systematic review and case report","volume":"8","author":"Matthews","year":"2017","journal-title":"Geriatr Orthop Surg Rehabil."},{"key":"R2-20250516","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1055\/s-0033-1353988","article-title":"Displaced patella fractures","volume":"26","author":"Della Rocca","year":"2013","journal-title":"J Knee Surg."},{"key":"R3-20250516","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/s13018-019-1385-5","article-title":"Management of comminuted patellar fracture fixation using modified cerclage wiring","volume":"14","author":"Sun","year":"2019","journal-title":"J Orthop Surg Res."},{"key":"R4-20250516","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1007\/s00402-022-04400-w","article-title":"3D reduction combined with the modified Kirschner-wire tension band for the treatment of comminuted patella fracture","volume":"143","author":"Gao","year":"2023","journal-title":"Arch Orthop Trauma Surg."},{"key":"R5-20250516","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jot.2020.10.003","article-title":"Comminuted patellar fractures: the role of biplanar fixed angle plate constructs","volume":"27","author":"Kfuri","year":"2021","journal-title":"J Orthop Translat"},{"key":"R6-20250516","doi-asserted-by":"crossref","first-page":"3287","DOI":"10.1007\/s00590-023-03597-9","article-title":"To plate, or not to plate? 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