Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

Abstract

Treatment of patella fractures is fraught with complications and historically poor functional outcomes. A fixation method that allows for early mobilization and decreases symptomatic hardware rates will improve knee range of motion, postoperative functional status, and reoperation rates. The purpose of this study was to evaluate the functional outcomes after locked plate osteosynthesis of patella fractures at a Level 1 trauma center. A retrospective case series was conducted of patients who underwent open reduction internal fixation (ORIF) of a patella fracture using a locked mesh plating technique coupled with neutralization of forces on the distal pole of the patella. Twelve patients were evaluated at a mean follow-up of 19 months (range, 6-30) with physical exam, functional outcomes, and radiographs. There were 9 women and 3 men with an average age of 66.1 years (range, 53-75). Radiographic bony union was achieved in all patients by 3-month follow-up. Visual Analog Pain Score averaged 1.7 (median, 1.0; range, 0-8), the mean Knee Outcome Score - Activities of Daily Living Scale was 83.9 (median, 92.1; range, 45.7-100.0), the mean Short Form Musculoskeletal Function Assessment (SMFA) Function Index was 9.9 (median, 3.7; range, 0.7-41.2), and the mean SMFA Bother Index was 11.1 (median, 3.1; range, 0-62.5). The SF-36 Physical Component Score mean was 48.4 ± 8.5 and the SF-36 Mental Component Score mean was 54.1 ± 9.6. No complications developed and there were no reoperations for nonunion, infection, or symptomatic hardware. This study demonstrates that locked plate osteosynthesis for operative patella fractures can reliably achieve bony union with potentially superior functional outcomes as compared with traditional methods. Further studies are needed to evaluate plate fixation for patella fractures, but early results are promising.

Three-dimensional fracture mapping of multi-fragmentary patella fractures (AO/OTA 34C3)

“…Tension band wiring has been widely used in the treatment of patella fractures, however, it is associated with poor functional outcome and surgical complications, including a high rate of implant removal (3)(4)(5). Recently, a number of studies demonstrated that low-profile plating could fix patella fractures rigorously and improve postoperative knee function, particularly in comminuted patella fracture patterns (6)(7)(8). It also should be noted that plates may be bulky and irritate soft tissues, thus increasing the risk of wound healing problems.…”

Anterior Locking Plate Osteosynthesis of Patellar Factures – Analysis of Complications and Functional Outcome

“…The complication rate of other studies on anterior locking plate fixation of the patella ranges from 0% to19% 26 , 27 , 28 , 29 , 34 , 35 , 36 . Apart from the leading complication of infections (27%), there was also a loss of reduction with avulsion of the inferior pole (36%).…”

“…Die Komplikationsrate anderer Untersuchungen zur winkelstabilen Plattenosteosynthese der Patella liegt bei 0 – 19% 26 , 27 , 28 , 29 , 34 , 35 , 36 . Dabei finden sich neben Infektionen (27% der Komplikationen) als führende Komplikation ein Repositionsverlust mit Ausriss eines distalen Polfragmentes (36%).…”

Adjunct neutralization plating in patella fracture fixation: a technical trick

“…[3] Osteoporotic bone, comminuted fractures, and inferior pole fractures, as demonstrated in our case series, are scenarios where plates can function as an adjunct to more common fixation methods. [7–13]…”