Patellar fractures: to plate them all? Results of a new treatment protocol

Introduction In recent years, anatomically contoured locking plates have been introduced as an alternative fixation method for patellar fractures. Biomechanical studies have demonstrated superior mechanical stability and clinical studies further suggest that plating reduces complication and revision rates, especially in comminuted fracture patterns. However, there is uncertainty regarding the role of plating in less complex fracture types. Following an institutional shift to routine plating of all surgically treated patellar fractures, this study compares outcomes and costs of plate versus non-plate fixation for patellar fractures. Methods Retrospective cohort at a level-I trauma center (2016–2023). Patients undergoing fixation with ≥6-month follow-up were included. Major complications were fixation failure or deep infection; minor included superficial infection, ROM <110°, persistent knee pain, or stair-climbing difficulty. Hardware removal was analyzed separately. Results 125 patients met criteria (48 plating; 77 non-plate); 70% had AO C1–C2 patterns. Major complications occurred in 4% after plating versus 15% with non-plate (p=0.07). Hardware removal rate was 8.3% with plating versus 26.0% without. Minor complication rates were lower with plating (p<0.05). ROM was better after plating (0–136°) than non-plate fixation (1–126°). Cost analysis showed higher primary cost with plating, offset by fewer complications, yielding a net additional expenditure of $6,413 overall. Conclusion Plating reduced complications and hardware removal and improved overall function, with modest additional cost.