Surgical factors associated with symptomatic implant removal after patella fracture. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Gupta, Jayesh; Harkin, Elizabeth A.; O'Connor, Katherine; Enobun, Blessing; O'Hara, Nathan N.; O'Toole, Robert V.
• Is Part Of: Injury. Volume 53:Issue 6(2022)
• Page Start: 2241
• Page End: 2246
• Publication Date: 2022-06
• Subjects: Symptomatic implant removal -- Patella fracture -- K-wires -- Predictors; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.03.028
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Individuals with k-wires were 4.9 times more likely to have symptomatic removal of implant. Implant prominence exceeding 5 mm might be associated with increased odds of symptomatic implant removal in patients with patella fractures. Patients with BMI ≤25 and age ≤45 were more likely to have symptomatic removal of implant. Abstract: Objectives: To determine whether certain types of fixation and other factors associated with the fixation could be identified that predict an increased risk of symptomatic implant removal. Methods: We conducted a retrospective cohort study at our urban academic level 1 trauma center. Patients aged ≥18 years who underwent operative fixation for patella fracture were included. The primary outcome was symptomatic implant removal after operative fixation. Results: Of the 186 study patients (mean age, 44 [SD 17] years, 65% male), 53 patients (28.5%) underwent symptomatic implant removal. Modifiable risk factors for symptomatic implant removal included the use of Kirschner (k)-wires (OR: 4.93; 95% CI, 1.89–14.10; p < 0.001), and a trend towards significance for implant prominence >5 mm (OR: 2.57; 95% CI, 0.93–7.93; p = 0.07). Symptomatic implant removal was also less likely in patients >45 years of age (OR: 0.14; 95% CI, 0.06–0.34; p < 0.01), of a racial minority (OR: 0.40; 95% CI, 0.17–0.88; p = 0.03), and a body mass index >25 kg/m 2 (OR: 0.39; 95% CI, 0.18–0.84; p = 0.02). The final model demonstrated excellent prognostic performance, with an AUC of 0.83 (0.76–0.90). Conclusion: We identified both modifiable and non-modifiable factors associated with symptomatic implant removal in patients with patella fractures. Surgeons should be aware that the use of k-wires and any implant prominence exceeding 5 mm might be associated with increased odds of symptomatic implant removal in patients with patella fractures.