![]() The full texts were obtained and reviewed by two independent authors to assess eligibility. Studies were assessed for eligibility in accordance with the criteria in Table 1. This systematic review excluded (1) studies not published in English, (2) articles composed of abstracts only, conference abstracts, editorial comments, or expert opinion, (3) basic science studies, review articles, or technique notes, and (4) case reports that included less than 10 cases. The selected studies satisfied the following criteria: (1) published in English, (2) included patients who underwent surgical fixation for inferior pole fractures of the patella, (3) classified as case–control studies and case series including 10 or more cases, and (4) reported validated outcome measures. ![]() (Full search strategies were provided in the Appendix 1). After the database search, the keywords were then entered into Google Scholar to identify potentially relevant omitted studies. This review searched PubMed, Scopus, and Web of Science using the following keywords in the title, abstract, and keywords sections of articles: “patella lower pole fracture,” “patella inferior pole fracture,” or “patella distal pole fracture.” The initial search was conducted in September 2022, and an updated search was conducted on March 7, 2023. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (registration number: CRD42022363822). Combinations of techniques are also employed to treat inferior pole fractures of the patella. Additional techniques frequently used for augmentation include the use of cerclage wiring (Fig. 1F) with or without partial patellectomy. 1E ), and transosseous reattachment (TOR Fig. 1B), and the use of separated vertical wiring (SVW Fig. Experts have proposed various techniques for treating inferior pole fractures of the patella, including patella plates (Fig. However, a comminuted fracture complicates surgery. Surgical treatment for displaced fractures of the inferior pole of the patella is recommended to restore the extensor mechanism of the lower extremity. Inferior pole fracture of the patella, a type of patellar fracture in which the patella is extra-articularly avulsed by the patellar tendon, accounts for 5% to 22.4% of all patellar fractures. Patellar fractures account for approximately 1% of all skeletal fractures in adults. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. ![]() The lowest functional score was also found in those using the patellotibial wire. Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device (2) tensile fixation device (3) mixed device and (4) extra-patella device. The follow-up period ranged from 6 to 300 months. Fourteen case–control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11–90). ResultsĪ total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. Studies were screened against predecided inclusion and exclusion criteria. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques.
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