The treatment for a synovial fistula is largely nonoperative. Most will resolve with a brief period of immobilization, which allows the fistula to close.9-10 Literature addressing fistulae that fail to heal with nonoperative treatment is limited. Excision and direct closure of the fistula, especially when chronic, often proves futile and leads to a high recurrence rate.11 An alternative but more extensive treatment involves excision and coverage with a myofascial flap.12
Complications reported after tension band plating are uncommon. Two studies reported no complications regarding the use of the tension band plate.1-2 Burghardt and colleagues,5 in reporting the results of a multicenter survey, found that 15% of surgeons who had used tension band plating had seen a total of 65 cases of mechanical failure. In all cases, the screws, not the plate, failed. Another study reported implant migration in 1 patient but attributed the complication to a technical error from placing the distal screw too close to the physis.4 A third study documented that 2 patients developed clinically significant recurvatum, most likely because of anterior placement of the plate.3 It is important to identify a synovial fistula postoperatively because it provides a direct route for pathogens from the external environment to enter the intra-articular space and the opportunity for a septic joint to develop. Infection should always be ruled out and, if present, appropriately treated.
Conclusion
Physicians performing tension band plating in the knee should be aware of the possible complication of a synovial fistula, which has traditionally been reported only in relation to knee arthroscopy. Given the proposed etiology of the synovial fistula, we recommend a brief period of immobilization of 3 to 5 days after tension band plate removal, allowing the capsular rent to heal and minimizing the risk of a synovial fistula.