Risk factors for reoperation following operative fixation of patella fractures

This study aimed to identify patient and injury characteristics associated with reoperation after patella open reduction internal fixation (ORIF).

A retrospective review was conducted of patients who underwent operative fixation of patella fractures (AO/OTA 34) from 2012 to 2022 at a single Level I trauma center. Demographic, injury, and operative variables were collected. Primary outcomes were all-cause reoperation, symptomatic implant removal (SIR), fixation failure, and fracture-related infection (FRI). Univariable and multivariable analyses were performed to identify factors associated with reoperation.

Of 497 identified patients, 251 met inclusion criteria. The mean age was 45.8 years, and 57.4% were male. Fifty-six patients (22.3%) required reoperation, most commonly for fixation failure (14.7%). Osteoporosis (33.9% vs 8.2%, p < 0.001), diabetes (23.2% vs 8.2%, p = 0.002), and tobacco use (53.6% vs 30.3%, p = 0.001) were more common among reoperation cases. On multivariable analysis, male sex (OR 2.73, 95% CI 1.07-6.91, p = 0.035), diabetes (OR 4.23, 95% CI 1.37-13.08, p = 0.012), and osteoporosis (OR 8.51, 95% CI 3.03-23.91, p < 0.001) were independently associated with fixation failure, whereas increasing BMI was associated with lower odds of fixation failure (OR 0.93, 95% CI 0.86-1.00, p = 0.049).

Reoperation occurred in approximately one in five patients following patella ORIF. Osteoporosis, diabetes, and tobacco use were associated with higher complication rates, while higher BMI was associated with reduced odds of fixation failure. Individualized surgical planning, bone health optimization, and closer follow-up may address complication risk in high-risk patients following patella fracture fixation.