Suture Button with Tension Band Fixation for Patella fractures: A Retrospective Case Series

There is a high rate of surgical complications and removal of symptomatic hardware for patients who have undergone open reduction internal fixation (ORIF) for transverse patella fractures. In recent years there has been increased interest in more low profile ORIF techniques to combat these issues. The aim of this study was to evaluate if a reduced hardware burden would correlate with fewer complications and equal rates of fracture union when compared to traditional techniques for treating transverse patella fractures.

Nine patient charts were retrospectively reviewed dating between June 2015 and March 2023. All patients sustained a transverse patella fracture and underwent ORIF with a suture button and suture tension band construct by a single surgeon. The primary outcome measure was rate of radiographic fracture union at final follow up. Secondary outcome measures included any need for removal of hardware or other revision procedure, surgical and medical complications, postoperative pain score and the ability to perform a straight leg raise.

Eight of nine patients demonstrated radiographic evidence of fracture consolidation with an average follow-up time of 17.9 months (range 12-26 months). One patient required an additional operation for revision ORIF before going on to successful union. No patients underwent a procedure for removal of hardware before final follow up. All patients were able to hold a straight leg raise at final follow up.

Suture button with suture tension band construct is a reasonable treatment option for treating transverse patella fractures. Surgeons may employ this technique for older patients or those with some fracture comminution, although there should be some caution and close follow up for displacement.