Early Outcomes After Surgical Management of Geriatric Patella Fractures

Complications following surgical treatment of patella fractures - a systematic review and proportional meta-analysis

PURPOSE

The aim of this systematic review and proportional meta-analysis was to identify complications of surgical treatment of patella fractures and to estimate their incidence. We extended existing knowledge on this topic by including several more recent and large-scale studies.

METHODS

This systematic review and meta-analysis were performed in accordance with the Cochrane Handbook for systematic reviews of interventions. After searching in PubMed, MEDLINE, EMBASE, Cochrane Library, and OpenGrey, all studies after 2000, with study populations > 100 patients, including only patients > 18 years and follow-up > 30 days, were included. Two independent authors assessed the literature search and extracted the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analysis was performed on complications pooled in infections, nonunion, symptomatic implant removal, and fixation failure.

RESULTS

The data on complications were available from 14 studies, including a pool of 5659 patients. The most common complication was symptomatic implant removal, affecting.

CONCLUSION

Surgically, treatment of patella fractures was associated with a high risk of complications. The most common complication was symptomatic implant removal, affecting 29.6% of patients. Other complications stated were fixation failure 5.2%, infections 3.1% and nonunion 1.7%.

High risk of complications following surgical treatment of patella fractures - a cross-sectional study of 798 patients with mean 6.4 years follow-up

PURPOSE

This study aimed to investigate the incidence of early and late complications following treatment of patella fractures. Secondary aims were to investigate the association between early and late complications and the patient-reported outcome measurement, the Knee Injury and Osteoarthritis outcome score (KOOS).

METHODS

Cross-sectional study including all patients recorded with a patella fracture residing in the Northern Region of Denmark between 2010 and 2020. Early (before 3 months) and late complications were investigated by retrospective review of charts and x-rays. All patients were invited to participate in the study by reporting current knee-specific symptoms. The KOOS was used to investigate patient-reported knee-specific symptoms.

RESULTS

Seven hundred ninety-eight patients were included in the study. A total of 532 (67%) patients were treated conservatively, and 266 (33%) patients underwent surgery. The mean age at the time of fracture was 66.8, ranging from 6 to 103 years of age. The mean follow-up time was 6.4 years, ranging from 1.1 to 12.3 years follow-up. Overall, the rate of complications was 26%. Overall, the rate of complication for the surgical group was 57% and for the conservative group 4%. The most common early complication was the loss of reduction followed by the removal of symptomatic hardware. The most common late complication was the removal of symptomatic hardware and knee arthroscopy. In all the five KOOS subscales (Pain, Symptoms, ADL, Sport/Rec, and QOL), patients presenting with early and late complications reported statistically significantly worse scores than those without complications.

CONCLUSION

The overall incidence of complications in patients presenting with a patella fracture was 26%, with a mean follow-up time of 6.4 years. In the surgical group, 57% of patients experience at least one complication during the follow-up period. Early and late complications were significantly associated with worse KOOS subscale  scores.

Comparative risk stratification for prediction of early postoperative morbidity and mortality after open fixation of periarticular lower extremity fractures

INTRODUCTION

The identification of patients at higher risk of early postoperative adverse events has implications for quality improvement, preoperative medical optimization, and cost reduction through bundled payments. The purpose of the present study was to develop points-based risk stratification systems for predicting 30-day adverse events (AEs) and mortality after open fixation of periarticular hip, knee, and ankle fractures.

METHODS

Query of the NSQIP database yielded 65,529 patients who underwent periarticular lower extremity repair from 2010 to 2019. To generate our risk stratification systems, 60% of patients were randomly analyzed with multivariable regression plus bootstrap modeling to identify independent risk factors for early AE or mortality. A nomogram analysis was then conducted to assign scores for each risk factor. To validate our models, the systems were tested for predictive ability using the remaining 40% of patients.

RESULTS

In total, 13,212 patients (20.2%) experienced any AE and 3613 patients (5.5%) mortality within 30 days of fracture fixation. Patients were assigned points for the following in both risk stratification systems: fracture type, male gender, age, functional dependence, anemia, pulmonary disease, congestive heart failure, and end-stage renal disease. Corticosteroid use, hypertension, and insulin-dependent diabetes were additional predictors for only AEs. The AE and mortality models had maximum scores of 27 and 17 points, and Harrell C statistics of 0.66 and 0.75, respectively. The estimated risk of developing early AE ranged from 3.4 to 79.5% and mortality from 0.08 to 54.4%.

CONCLUSION

Fracture type and preoperative characteristics can be used in the prediction of early AE or mortality following open fixation of periarticular lower extremity fractures, with a marked disparity in estimated risks depending on the number of risk factors possessed by a patient.

LEVEL OF EVIDENCE

Therapeutic IV.