Abstract
BACKGROUND: Due to the patella's thin overlying skin, metal implants frequently cause local discomfort that necessitates removal. This study aimed to evaluate the intraoperative and early postoperative outcomes of treating comminuted patellar fractures using non-absorbable sutures as the sole internal fixation method via the Nice knot technique. METHODS: This retrospective study reviewed 25 patients with unilateral closed comminuted patellar fractures who underwent open reduction and internal fixation using either non-absorbable sutures tied with a Nice knot (NK group, n = 12) or the traditional tension band technique (TB group, n = 13). Intraoperative surgical time and blood loss were recorded. Postoperative clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for pain, knee range of motion (ROM), and the Böstman scoring system. Radiographic assessments were conducted to evaluate fracture healing. Complications, including infection, implant loosening, and discomfort or irritation, were also documented. RESULTS: Although the intraoperative surgical time was slightly longer in the NK group compared to the TB group, the difference was not statistically significant. The difference in blood loss between the NK and TB groups was also not statistically significant. No cases of bone non-union, implant loosening, or internal fixation failure were observed in either group during the follow-up period. One patient in the TB group developed a wound infection one week postoperatively. At the final follow-up, there were no significant differences between the two groups in terms of VAS scores, knee range of motion (ROM), or Böstman scores. However, in the TB group, five patients reported notable discomfort or irritation caused by the internal fixation. CONCLUSION: Compared with traditional tension band fixation, the Nice knot technique reduces soft tissue irritation, avoids implant removal surgery, potentially lowers postoperative infection rates, and achieves comparable fracture healing time and knee function. However, broader validation through multi-center studies is required.