Metallic Implants for Patellar Fracture Fixation: A Systematic Review

Background: Although tension band wiring is the traditional method to fix the transverse patellar fracture, there are many published studies regarding the use of other metallic implants to fix the patellar fracture. This study aims to find out the good choice of fixation by performing a systematic review of the literature to compare clinical and radiological outcomes of the studies that use metallic implants to fix transverse patellar fractures. Methods: The following keywords (patella cerclage, patella wire, patella plate, patella fixation, tension band) were used to perform a systematic search of literature until 2021. All abstracts were reviewed, and the selection of these abstracts was then performed based on the inclusion and/or exclusion criteria. Results: A total of 19 studies involving 1264 patients were included (623 males and 641 females). The tension band with K wires method was the most used method in the studies followed by tension with cannulated screws, plates, and lag interfragmentary screws respectively. 95.4 % of patients had a complete union. TBCS had lower postoperative complications, less hardware failure, and short healing time, but no significant difference between TBCS and TBKW regarding the range of motion and operative time. Conclusion: TBCS technique had a low risk of hardware failure and complication in comparison to the TBKW technique while no superior method regarding ROM and operative time. On the other hand, plate osteosynthesis and isolated interfragmentary screws may provide other choices for the fixation of transverse patella fractures but it needs more trials and studies to be confirmed to be effective.