Internal fixation of comminuted patellar fractures with only non-absorbable suture via Nice knot: a retrospective study

Purpose To evaluate intraoperative and early postoperative clinical outcomes using non-absorbable suture as the sole internal fixation method in comminuted patellar fractures via the Nice knot technique. Methods This study retrospectively reviewed 25 patients with unilateral closed comminuted patellar fractures, who received open reduction and internal fixation utilizing either non-absorbable sutures tied with Nice knot (the NK group, n = 12) or traditional tension band (the TB group, n = 13). Intraoperative surgical time and blood loss were recorded. The postoperative clinical outcomes were assessed using visual analgesic score (VAS), range of motion (ROM) of the knee, and Böstman scales. Radiographic outcomes were used to evaluate fracture healing. Complications such as infection, implant loosening and feeling of discomfort or irritation were also documented. Results Compared to the TB group, the intraoperative surgical time in the NK group was slightly longer; however, the difference was not statistically significant. The difference in blood loss between the NK group and TB group was not statistically significant either. The mean follow-up durations for patients in the NK and TB groups were 16.17 months and 15.38 months, respectively. No case of bone non-union, implant loosening and internal fixation failure was reported during follow-up period in both groups. One patient in the TB group experienced a wound infection one week postoperatively. There was no significant difference in the VAS, knee ROM, and Böstman scales at last follow-up between the two groups. In the TB group, 5 patients reported significant discomfort or irritation due to the internal fixation. Conclusion Compared to the traditional tension band fixation method, the Nice knot fixation offers several advantages, including reduced discomfort from soft tissue irritation, elimination of the need for subsequent surgical removal of the implant, potential reduction in postoperative infection rate, and satisfactory postoperative fracture healing time and knee joint function. However, future studies are necessary to validate these findings across broader patient populations and different clinical settings.