Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study

Dickens, Aaron J.; Salas, Christina; Rise, LeRoy; Murray‐Krezan, Cristina; Taha, Mahmoud Reda; DeCoster, Thomas A.; Gehlert, Rick J

doi:10.1016/j.injury.2015.02.017

Cited by 45 publications

(34 citation statements)

References 32 publications

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“…An operator can control the degree of tightness to the maximum extent; this is especially important for osteoporotic patients. 17,18 Because of these advantages of a titanium cable, patellar fractures can be fixed more firmly without causing loosening, thus facilitating the early functional exercise of the knee joint.…”

Section: Discussionmentioning

confidence: 99%

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Zhao¹,

Gu²,

Cheng³

et al. 2017

Adv Clin Exp Med

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Section: Discussionmentioning

confidence: 99%

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Zhao¹,

Gu²,

Cheng³

et al. 2017

Adv Clin Exp Med

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“…Dickens et al compared biomechanical fixation strength of titanium, neurosurgical, cranial mesh plates with standard steel wire tension band constructs in transverse patella fractures using 24 synthetic patella. 17 The titanium mesh plate was just as effective in stiffness and force at failure and was found to have a smaller mean fracture gap at failure. Similarly, locked X-plate fixation has been found to have no difference in load to failure, 26 with decreased fracture gapping in fixed angle plating as compared with tension band constructs.…”

Section: Discussionmentioning

confidence: 96%

“…Case series of patellar plating have been published [12][13][14][15] and biomechanical studies have demonstrated equal or superior fixation strength with plates as compared with tension banding. 16,17 In this series, we examined patient-reported outcomes, range of motion (ROM), and complication rates in patients following plate fixation of patella fractures. The purpose of this study was to evaluate functional outcomes after plate osteosynthesis of patella fractures.…”

mentioning

confidence: 99%

Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

et al. 2018

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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.

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“…There have been three biomechanical studies and one clinical study that reported on the use of a locked plate for patella fractures. Dickens et al 4 reported the use of a titanium mesh plate in a biomechanical study using a transverse fracture model. The mesh plate was found to be noninferior to standard screw and wire tension band constructs.…”

Section: Discussionmentioning

confidence: 99%

The Use of Mesh Plates for Difficult Fractures of the Patella

Volgas

Dreger

2017

J Knee Surg

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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.

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Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study

Cited by 45 publications

References 32 publications

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

The Use of Mesh Plates for Difficult Fractures of the Patella

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