I have used Synthes (calcaneal) mesh plate for severely comminuted patella fractures (off-label). You can essentially fix each comminuted fragment through a plate hole - preserves the fragments with good fixation. However, the overlying skin is very thin and patients will feel the subcutaneous hardware, which may pose a symptomatic problem.

Thanks Dr Jerome for the insight and the feedback. 

I never use mesh or plates for patellar fractures for the reasons shared above. Weber tension wiring works well and stood the test of time. Additional fragments could be fixed with small instrumentarium screws or K-wires.

I have used 2-3 cannulated screws and put a braided wire through them to function as tension wires. It gives you less compression but withelds the tension band principle.

we have a patellar claw implant available at our institution that clings together a lot of fragments together. in my opinion every implant for patella becomes symptomatic owing to the subcutaneous location.

Fixation of  comminuted patellar fracture , by whatever way you do it, the main aim is to restore a reduced articular surface. If I think that is possible I hold the fragments together with a marselene Tape in the periphery and gradually tightening the note kepping my two fingers in the articular surface of the patella through a rent in the Quadriceps expansionand after reducing the joint and tightening the the marselene knot, I do tension Band wiring. I do not think Titaneum mesh is better than this procedure

I recently went to a trauma conference where they showed that the mesh plate can be contoured to apply only to the lateral border of the patella for multiple points of fixation, obviating the problem of prominent subcutaneous hardware.