Abstract
Background:
Patellar fractures are knee-related injuries with variable fracture morphology and diverse surgical treatment approaches. The aim of this study was to describe epidemiological characteristics, treatment strategies, and temporal developments of operative management in Germany between 2019 and 2023, based on national inpatient routine data.
Methods:
This retrospective, descriptive analysis was based on nationwide InEK hospital data (§21 KHEntgG) from 2019 to 2023. All inpatient cases with the main diagnosis S82.0 (fracture of the patella, ICD-10-GM) were included. The parameters analyzed were total case numbers, frequency of surgical treatment, type of reduction, fracture morphology (simple vs. multifragmentary), osteosynthesis techniques (tension band wiring, screws, plates), and frequency of patellectomies. Associated injuries were identified using secondary ICD-10 codes. Additional analyses were performed by age group, sex, and incidence per 100,000 inhabitants.
Results:
A total of 46,046 inpatient patellar fractures were identified. The annual number decreased from 10,094 (2019) to 9,142 (2023), corresponding to an incidence drop from 12.14 to 10.80 per 100,000 inhabitants. Women accounted for more than 66% of cases, and over 60% of patients were aged ≥65 years. The proportion of operative treatments increased from 73.0% (2019) to 88.4% (2023), with open reductions dominating (mean 96.1%).
Multifragmentary fractures comprised over 70% of cases. Tension band wiring remained the most common fixation method but declined from 60.4% to 48.1%, while plate osteosynthesis increased markedly (12.8% to 28.4%). Screw fixation showed a slight decrease.
Partial patellectomies remained stable at about 1%, and total procedures were rare (<0.2%). The most frequent associated diagnosis was grade I soft-tissue injury in closed fractures (42.9%), followed by periarticular tendon lesions (3.6%), patellar dislocations (2.5%), and chondral defects (1.3%). Fractures of adjacent structures, ligamentous injuries, and fibular nerve lesions were each coded in fewer than 1% of cases.
Conclusion:
The results demonstrate an increasing trend toward operative management of patellar fractures in Germany and a marked rise in plate fixation techniques during the observation period. The frequent documentation of concomitant injuries and the predominance of elderly patients highlight the need for differentiated, patient-centered treatment strategies.
