ARTICLE IN PRESS JID: JINJ [m5G;November 21, 2020;3:13] Injury xxx (xxxx) xxx Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury Patella fracture ﬁxation with a non-locked anterior plating technique: A biomechanical study Daniel M Elkin a , Joseph D Galloway b,* , Kenneth Koury c , Jake J Ni b , Mark C Reilly b , Mark R Adams b , Michael S Sirkin b a Hope Orthopedics of Oregon, Salem, OR b Department of Orthopaedic Surgery, Rutgers - New Jersey Medical School, Newark, NJ c Geisinger Orthopaedics, Wilkes-Barre, PA a r t i c l e i n f o Article history: Accepted 15 November 2020 Available online xxx a b s t r a c t Objectives: The purpose of this study was to compare the biomechanical attributes of patella fracture ﬁxation with either anterior plating utilizing two parallel, longitudinal 2.0 mm plates technique versus a cannulated screw tension band technique. Methods: Five matched pairs (ten specimens) of fresh frozen cadavers were utilized. A transverse patella fracture (OTA 34C1.1) was ﬁxed using either two 4.0 mm cannulated screw anterior tension band (CATB) or with two 2.0 mm stainless steel non-locking plates along the anterior cortex secured with 2.4 mm cortical screws traversing the fracture site. Specimens underwent 1000 cycles of simulated active knee range of motion before load to failure destructive testing. Results: During cyclic loading there were no failures in the plate ﬁxation group, and 2 out of 5 speci- mens catastrophically failed in the CATB group (p = 0.22). Average fracture displacement at the end of fatigue testing was 0.96 mm in the plate ﬁxation group and 2.72 mm in the CATB group (p = 0.18). The specimens that withstood cyclic testing underwent a destructive load. Mean load to failure for the plate ﬁxation specimens was 1286 N, which was not signiﬁcantly different from the CATB group mean of 1175 N (p = 0.48). The mechanism of failure in the plate ﬁxation cohort was uniformly via a secondary vertical patella fracture around the plates in all ﬁve specimens. In the CATB group, the mechanism of failure was via wire elongation and backing out of the screws. Conclusions: Patella ﬁxation with anterior plating technique statistically performed equivalent to can- nulated screw anterior tension band in ultimate load to failure strength and fatigue endurance under cyclical loading. No failures were observed cyclic simulated active range of motion in the anterior plate group. There was a trend towards improved fatigue endurance in the plate ﬁxation group, however this did not reach statistical signiﬁcance. We believe plate ﬁxation technique represents a low-proﬁle implant option for treatment of transverse patella fractures, which may allow for early active range of motion, and these data support biomechanical equivalency to standard of care. © 2020 Elsevier Ltd. All rights reserved. 1. Introduction Patellar fractures account for about 1% of all bony fractures, with the transverse pattern predominating [1,2]. Non-operative management, partial and total patellectomy, suture ﬁxation, cir- cumferential cerclage wires, tension bands, lag screws, and plates have all been used alone or in combination to manage patella frac- * Corresponding author at: Ambulatory Care Center, 140 Bergen Street Room D1620, Newark, NJ 07101. E-mail address: jdg207@njms.rutgers.edu (J.D. Galloway). tures over the year [3–8]. Currently, one of the most commonly ac- cepted open reduction and internal ﬁxation method to treat trans- verse, non-comminuted patellar fractures is the anterior tension band (ATB) technique, which utilizes parallel longitudinal Kirsh- ner wires (K-wires) over which a 14 gauge stainless steel wire is looped in a ﬁgure-of-8 tension band across the anterior patella [1,9]. Many reports of hardware failure and symptomatic hardware were subsequently reported [10,11]. To address the problems asso- ciated with the ATB method, many variations of the ATB have been developed including substituting cannulated lag screws for the K- wires (cannulated screw anterior tension band - CATB) as well as https://doi.org/10.1016/j.injury.2020.11.040 0020-1383/© 2020 Elsevier Ltd. All rights reserved. Please cite this article as: D.M. Elkin, J.D. Galloway, K. Koury et al., Patella fracture ﬁxation with a non-locked anterior plating technique: A biomechanical study, Injury, https://doi.org/10.1016/j.injury.2020.11.040