Patellar fractures account for approximately 1% of all fractures, with multifragmentary fractures representing 55% of surgically treated cases. These fractures require anatomical reduction and stable fixation to restore joint congruency and enable early rehabilitation. While the traditional tension band wiring (TBW) method is widely used, it is associated with a high reoperation rate (up to 65%), complications, and soft tissue irritation. Conversely, mesh plates provide more stable and less prominent fixation, presenting a promising alternative for complex patellar fractures. The aim of this systematic review was to evaluate properties such as bone union time, range of motion (ROM), and complications between TBW and mesh plates in patients over 18 years old with multifragmentary patellar fractures. This review followed PRISMA guidelines, with the protocol registered in PROSPERO. Studies included patients over 18 years old with multifragmentary patellar fractures treated with mesh plates or TBW. Evaluated outcomes included bone union time, ROM, and complications. Three reviewers independently extracted data and assessed the risk of bias in the selected studies. From 744 initially identified articles, 17 studies (388 patients) were included after title, abstract, and full-text screening. Among the analyzed studies: mesa plates results varied with plate thickness, with thicker plates (≥2.4 mm) achieving better ROM (up to 143°). Complications were rare, with isolated cases of irritation and hardware removal. Tension band wiring achieved good ROM results (90°-130°) and bone union times but had a higher incidence of complications, including wire migration, stiffness, and nonunion. Combined techniques (mesh plate + TBW) demonstrated the best results, with an average ROM of 123.5°, faster union times (21.5 months), and no reported complications. The combination of mesh plates and TBW offers superior outcomes in terms of ROM, joint stability, bone union time, and postoperative pain compared to the individual use of either technique. While TBW remains effective, it has a higher complication rate. Further studies with larger samples and robust designs are needed to establish clear guidelines for the ideal surgical method for multifragmentary patellar fractures.
Galvan et al. (2026) studied this question.