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The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable focus on the use of non-metallic implants. The aim of this study was to determine the differences in clinical outcomes, including the rates of complications and re-operations following the surgical management of patellar fractures with metallic versus non-metallic implants.The systematic review was conducted in accordance with PRISMA guidelines. Two investigators independently applied the search strategy to PubMed, SCOPUS, Google Scholar, and Cochrane databases, limited to publications between 1st January 2000 to 30st September 2021. The search strategy identified studies in which there was a comparison between the clinical outcome of the metallic and non-metallic fixation. Meta-analysis was conducted according to the Cochrane Collaboration and Quality of Reporting of Meta-Analysis (QUORUM) guidelines.A total of 19 studies were selected for the systematic review and seven studies for the meta-analysis. Two hundred ninety-sixt patients formed the pooled study population for the meta-analysis. The outcomes evaluated in the meta-analysis were range of motion (ROM), complications, and re-operation rates. There was no significant difference between groups regarding ROM, but the risk ratio (RR) of re-operation (RR 0.19, 95% CI [0.09-0.41]) and complications (RR 0.30, 95% CI [0.17-0.55]) was significantly in favor of fixation with non-metallic implants.The use of non-metallic implants for fixation of patella fractures was associated with significantly lower risk of complications and re-operations than fixation with metallic implants, without any difference between groups with respect to the final range of motion or functional outcome measures.

Patellar fractures are relatively uncommon; transverse displaced patellar fractures need surgical treatment, and the most widely used technique requires the use of metallic hardware. Despite good clinical outcomes, there are some possible complications related to the hardware. In this paper, we report a case of a 61 years-old woman that presented in 2001 with a fracture of the right patella that was treated with metallic hardware in another Hospital. After two months, the patient reported an infection of the hardware that became osteomyelitis, requiring several surgeries before achieving complete healing. The infection was eradicated, and the patient reached a good functionality of the right knee after two years from the first surgery. In 2019, she presented in our hospital with a displaced transverse fracture of the left patella. After a careful evaluation of the case, considering all the patient's comorbidities, allergies and the complications related to the previous treatment of the right patellar fracture, we decided to treat this fracture with non-metallic hardware (FiberTape Cerclage, Arthrex Inc., Naples, FL, USA). After surgery, the patient did not report any complications; the fracture was healed at the last x-ray follow-up (6 months), and the patient reached a good functional outcome of the left knee. Based on this case report, in this particular patient, the use of non-metallic hardware for patellar fracture fixation allowed us to obtain good results with no complications. However, this is only a case report, so the reliability of the proposed treatment cannot be directly concluded. Moreover, on the base of this case report, it is not possible to extrapolate the result in the routine treatment of patellar fractures.

Background Interstitial lung disease (ILD) is the most frequent type of organ involvement and the main cause of death in systemic sclerosis (SSc). The trigger of fibrosis is an immune mediated alveolitis, thus in the last years, several immunosuppressant drugs have been put to the test, mostly cyclophosphamide (CYC), azathioprine (AZA) and mycophenolate mofetil (MMF). Therefore, also in the Rheumatology Unit of Padua University, in recent years have been treated in with immunosuppressive therapy. Aim The aim of our study was to evaluate the efficacy of MMF as a first-line drug on pulmonary function in SSc-related ILD patients and compare them to a historical group of SSc patients treated with CYC followed by AZA. Moreover, it has been assessed the safety of each immunosuppressant drugs. Methods Eighteen patients with SSc-related ILD have been investigated and treated with MMF as first-line therapy for two years. Fifteen patients, instead have been treated one year with CYC and for and with AZA for the second years. The two groups of patients have been evaluated at baseline, and then after 12 and 24 months of therapy. The evaluation parameters were: pulmonary function tests (FVC and DLCO), HRCT score and NYHA class. The comparison between the two groups was assessed using Pearson’s chi-square test, student t test and Wilcoxon signed rank test as statistical approaches. Results At baseline, patients characteristics appeared homogeneous between the two groups and non-statistically significant increase of FVC was observed in both groups at month 12 and month 24. In the group treated with MMF no patient has deteriorated in NYHA functional class, respiratory tests showed an average stability pulmonary function and no patient has progressed in the TC score. In the control group, treated sequentially with CYC and AZA, has no been shown significant difference in NYHA class, respiratory tests, or in score TC. Comparing the two groups, no resounding significant difference has been highlighted. for the evaluated clinical parameters, showing similar efficacy of MMF compared to a pattern of traditional immunosuppressive therapy. In the group treated with MMF no patients reported adverse events than can cause discontinuation of treatment, while in the control group, 2 patients had to interrupt the CYC for leukopenia, and 5 had suspended AZA, 2 for hepatotoxicity and 3 for leukopenia. The difference between the two groups respect to adverse events was statistically significant in favor of MMF (p = 0.0046). Conclusions The data of our study suggest that the immunosuppressive therapy with MMF administered for a period of two years has led to a stabilization of ILD in a cohort of SSc patients, as shown by respiratory test, the HRCT score, and functional class NYHA. Similar results have been observed in another group cohort of patients treated sequentially for two years with CYC and AZA. Besides, MMF treated group presented a significant decrease of side effects, compared to the group treated with CYC and AZA.