Abstract
INTRODUCTION: Comminuted patellar fractures, particularly AO/OTA 34-C2 and C3 fractures, present substantial challenges in achieving stable fixation and anatomical reconstruction. Conventional tension-band wiring may fail in such cases due to insufficient mechanical stability. This study aimed to evaluate the clinical and functional outcomes of a fracture pattern-driven plate osteosynthesis technique using multiple miniplates tailored to the intricate morphology of multifragmentary patellar fractures. METHODS: A retrospective review was conducted of 62 patients with AO/OTA 34-C2 or C3 patellar fractures treated between 2018 and 2023 at two academic trauma centers. All patients underwent fixation using a fragment-specific approach involving anterior tension-band plating and miniplates, guided by preoperative CT-based fracture mapping. The outcome measures included radiographic reduction quality, union rate, range of motion (ROM), Lysholm score, and isokinetic quadriceps strength at 6 and 12 months. RESULTS: Anatomical or good reduction was achieved in all cases (72.6% anatomical, 27.4% good), with a 100% union rate and low complication rate (3.2% reoperation rate). The mean final ROM was 132.9° ± 6.8°, and Lysholm scores improved from 70.3 ± 10.0 at 6 months to 89.1 ± 6.7 at 12 months. However, isokinetic peak torque deficits persisted at 12 months (mean 24.6% ± 13.0), and the body mass–normalized extension torque averaged 0.99 ± 0.40 Nm/kg, indicating residual muscle weakness despite rehabilitation. CONCLUSION: The fracture-pattern-driven osteosynthesis technique using multiple miniplates offers a reliable method for managing complex patellar fractures, providing excellent reduction quality, high union rates, and satisfactory functional outcomes. This approach enables individualized fixation strategies tailored to fragment morphology. Despite good clinical recovery, persistent deficits in quadriceps strength highlight the need for prolonged rehabilitation beyond 12 months to achieve complete functional restoration.