Abstract
Patella fractures present some of the more complicated fracture patterns in orthopaedic
trauma care. This is partially due to the small size of the fragments but also the
articular nature of each fragment. Fixation methods such as cerclage wiring, excision
of smaller fragments, and screw fixation of larger fragments all have their own challenges.
Our study examined our Level I trauma center's experience with variable angle locked
2.7 mm titanium plates for treatment of comminuted patella fractures or treatment
of patellar nonunion. After Institutional Review Board approval, we used billing records
to identify 105 patients who had undergone operative management of a displaced patella
fracture between January 2011 and December 2015. We reviewed the radiographs of these
patients to identify which patients underwent treatment with a mesh plate. We found
16 patients (6 males and 10 females) who had undergone fixation with a mesh plate;
mean age was 47 years. Nine patients underwent primary open reduction internal fixation
(ORIF) and seven underwent mesh plate fixation for failed ORIF of a patella fracture.
The mean visual analog pain score was 2.75 (range, 0–9). The mean range of motion
was 1 degree of extension (range, 0–10 degrees) to 110 degrees of flexion (range,
45–135 degrees). All fractures healed. Five patients required hardware removal for
pain. This review illustrates the effectiveness of the locking mesh plate in two challenging
clinical scenarios: that of patellar nonunion and comminuted fractures that preclude
standard fixation methods. Although multiple options exist for patellar fracture fixation,
the titanium mesh locking plate can be an effective option for retaining the patella
in the setting of comminution. Further comparative studies should be undertaken to
determine which method of treatment may be superior in the treatment of these fractures.
Keywords
patellar fractures - patellar nonunion - osteoporosis - fixation - mesh locking plate
