Functional Outcome of Transosseous Krackow Suture Repair for Lower Pole Patella Fracture

Abstract

Lower pole patella fractures, though relatively uncommon, present significant management challenges due to their impact on the extensor mechanism and the small, often comminuted nature of the fracture fragment. Traditional fixation methods such as tension band wiring and partial patellectomy have shown limitations, including implant-related complications and compromised functional outcomes. This prospective observational study aimed to evaluate the short-term functional and radiological outcomes of transosseous Krackow suture repair in lower pole patella fractures at a tertiary care center in Islamabad. Study was conducted at Combined Military Hospital (CMH), Rawalpindi, from January 2021- June 2023. A total of 105 patients (mean age 39.4 ± 12.6 years; 68.6% male) were treated surgically using non-metallic transosseous Krackow sutures. Patients were assessed at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively for union rates, range of motion, Lysholm knee scores, and complications. Radiological union was achieved in 96.2% of cases within an average of 10.3 weeks. The mean Lysholm score at six months was 88.6 ± 7.9, with 92.3% of patients regaining flexion >120° and 95.2% achieving full extension. Complications were minimal (7.6%), including superficial infections, reoperations due to suture failure, and hardware irritation. These findings indicate that transosseous Krackow suture repair is a safe, effective, and minimally invasive technique for lower pole patellar fractures. It provides reliable fixation with excellent functional outcomes and a low complication profile, making it a viable alternative to traditional fixation methods, particularly in resource-limited settings.