Like most bone deficits, mandibular segmental defects may result from surgical reconstruction due to congenital deformity, tumor resection, other pathologies, senescence, trauma, or infection. The goals of mandibular reconstruction are to restore the mandible's function and normal appearance. Clinical methods to restore the mandible typically rely on bone replacement using some combination of bone tissue transfer and metal implants. This paper reviews the safety, design, and efficacy of metal implants in general and specifically for the repair of mandibular segmental defects. These problems include implant incorporation, implant failure mechanisms (e.g., stress concentration, stress shielding), corrosion and toxicity, infection, and muscle re-attachment. Finally, this paper presents the use of porous nickel-titanium (NiTi) implants for the repair of skeletal defects through the example of mandibular segmental defects. Resorbable magnesium, and porous and non-porous NiTi, immobilization hardware are also discussed. These materials provide new options which may better match the material properties, and if they can be 3D printed, better match the shape of surrounding host tissue. These advances might reduce engrafted bone and metal implant failure and restore musculoskeletal function for the long term. Patient-specific hardware and grafting strategies might prove to be useful tools in determining both the patient's appearance and functional outcome following reconstructive musculoskeletal surgery.
Purpose
Basicervical femoral neck fractures are uncommon injuries that occur at the extracapsular base of the femoral neck at its transition with the intertrochanteric line. Controversy remains in the orthopedic literature as to the optimal method of treatment for this fracture type given the inherent instability and greater rate of implant failure with traditional fixation constructs. The purpose of this study is to quantify the incidence and preferred treatment methods of basicervical hip fractures at a single, regional, Level 1 trauma center and to identify differences in postoperative complications between treatment options.
Methods
The present study is a retrospective case series from a single regional health network, including 316 patients with hip fractures. Basicervical femoral neck fractures were identified. Reoperation rates within 90 days, implant failures or nonunions, postoperative ambulation distances and range of motion, and discharge dispositions were compared across patients grouped by surgical treatment with either cephalomedullary nail, sliding hip screw, or hemiarthroplasty (HA).
Results
Basicervical femoral neck fractures represented 6.6% of this study population. The cephalomedullary nail group demonstrated rates of implant failure and return to the operating room within 90 days of 40% (4/10) and 20% (2/10), respectively. No patients who underwent hemiarthroplasty experienced a failure of fixation or return to the operating room.
Conclusions
This study suggests a much lower rate of fixation failure or need for reoperation with hemiarthroplasty treatment compared to cephalomedullary nail construct for basicervical femoral neck fractures and may be an underutilized treatment method for this fracture type. The promising results seen with this case series should encourage further investigation into HA as a primary treatment for these uncommon, yet challenging, fractures.
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