All consecutive patients undergoing ORIF with tension band technique for closed patella fracture during the period of June 2017 to February 2021 at our institution were included in this study. This retrospective study was approved by the Institutional Review Board (IRB) of our institution. In this study, we aimed to develop a radiographic measurement to evaluate the thickness of surrounding soft tissue of the knee and determine its relationship with wound complications after ORIF of patella fractures. Almost all of the patients undergoing patella fracture operation receive imaging examination preoperatively, especially knee X-ray radiograph, which may serve as a potential tool. However, there is a lack of an accessible and feasible tool to assess periarticular soft tissue envelope size. Besides, surrounding soft tissue of the knee may be swelling in the patients with patella fracture, which may also increase the risk of wound complication. However, BMI has limitations, including neglecting variations in body habitus and local adiposity. Body mass index (BMI), which is a convenient tool to evaluate obesity in clinical practice, is widely used in the previous studies. Therefore, we hypothesize that obesity may be associated with wound complication after patella fracture operation. Obesity has widely proven to be a risk factor for infection after orthopaedic surgeries, especially in the lower limb fracture surgeries, including acetabular fracture, femoral neck fracture, distal femur fracture, tibial fracture, ankle fracture, and calcaneal fracture. However, there are limited studies to explore the risk factors for wound complications in these patients. Postoperative infections usually require local wound care, antibiotic therapy, operative debridement or hardware removal, which may prolong hospital stay, increase treatment expense, and decrease patient satisfaction. The incidence of infection following patella fracture operation varies from 1.5–10%, mainly because of different surgical techniques. However, symptomatic complaints and functional deficits may be caused by postoperative complications, which include loss of reduction or fixation, symptomatic hardware, nonunion, infection, and soft tissue problems. The goals of surgery are to restore the congruency of patellofemoral joint and the function of extensor mechanism. Open reduction and internal fixation (ORIF) is commonly used to treat displaced patellar fractures. Besides, the patella can be damaged indirectly by a sudden tensile force with hyperflexion of the knee. A direct blow is the most common cause of patella fractures. Peak age of affected patients is 10–19 years old in males and 60–80 years old in females. The reported incidence of patella fracture ranges from 10.5–16.5/100,000/year. Patella fractures account for about 1% of all skeletal injuries. Patella transfers the tensile force from the quadriceps to the patellar tendon, which results in the knee extension. Patella is the largest sesamoid bone of the human body and an important component of the extensor mechanism of the knee. The increased fPSTTR was associated with wound complications after ORIF of patella fractures. PSTTR was a feasible method to assess periarticular soft tissue. In the ROC analysis of fPSTTR predicting postoperative wound complication, the area under curve (AUC) was 0.676, which indicated a moderate predictive value. fPSTTR proved to be associated with postoperative wound complication. The average femoral PSTTR (fPSTTR) was 0.94 ± 0.17 and the average tibial PSTTR (tPSTTR) was 0.66 ± 0.16. Minor wound complication occurred in 24 patients, and major wound complication occurred in one patient. The incidence of postoperative wound complication was 10.5%. A receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PSTTR. Univariate analysis was performed to identify the association between PSTTR and postoperative wound complication. We established periarticular soft tissue thickness ratio (PSTTR) to evaluate soft tissue status on lateral knee X-ray radiographs. We retrospectively studied 237 patients undergoing ORIF for patella fractures from June 2017 to February 2021 at our institution. The purpose of this study is to determine the relationship between periarticular soft tissue thickness and wound complications after ORIF of patella fractures. Periarticular adiposity and swelling may be associated with wound complications. Wound complications after surgery often lead to prolonged hospitalization and dissatisfaction of patients. Displaced patella fracture is commonly treated with open reduction and internal fixation (ORIF).
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