CASE REPORTS: Management of Large Segmental Tibial Defects Using a Cylindrical Mesh Cage

Abstract

We report a case series of three patients who sustained open Gustilo-Anderson Type IIIB tibia fractures associated with extensive segmental bone and soft tissue loss. The patients initially were treated with serial wound irrigations, débridements, and external fixation. After the soft tissue envelope was reconstructed successfully, each large segmental bone defect was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with a statically locked intramedullary nail. The mean segmental bone loss was 12.2 cm, and all patients had a minimum 1-year followup. One year after reconstruction, radiographs showed stable, well-aligned, healed constructs, and computed tomography images verified the presence of bony ingrowth throughout the cages. All patients were able to ambulate with full weightbearing, and had good ipsilateral knee, hip, and ankle range of motion. This technique seems to be a reasonable alternative for treating large segmental tibial bone defects.

Micro-computed tomography prediction of biomechanical strength in murine structural bone grafts

“…A more thorough analysis of the effects of the lower resolution on the graft and callus volume computation and the predictive correlations with biomechanical properties would have to be performed in large animal preclinical and future human clinical studies. Regardless, there are clinical reports that strongly suggest the value of CT imaging, despite the low resolution limitations, in the management of massive long bone allografts (Manfrini et al, 2004;Attias and Lindsey, 2006). However, these limited studies do not report any quantifiable correlations between CT parameters and functional recovery, which underscores the importance of delineating such correlations in the preclinical mouse femoral graft model as a first step towards clinical translation.…”

Techniques in Skeletal Reconstruction After Bone Resection for Osteomyelitis

“…Composite grafts using bone marrow aspirate concentrate in combination with a collagen sponge or porous hydroxyapatite granules as a scaffold has reported encouraging results. Implanting graft materials into a well-developed vascularized membrane soft tissue envelope, the Masquelet technique, 8,9 as well as titanium segmental bone replacement 10 have all been shown to be successful approaches in reconstructing chronic segmental bone loss.…”

Nonunion and Osteomyelitis Following Fractures

“…Specimens of purulent fl uid, soft tissue, and bone from the infected area should be sent for aerobic and anaerobic cultures; it is also important to perform cultures for fungi and granulomatous infections in immunocompromised patients. The wound should be irrigated with a copious amount of saline solution, and antibiotics may be added to the terminal liter of the irrigation fl uid [ 19 ]. After irrigation, all gowns, gloves, drapes, and instruments should be changed with a new, clean setup (double setup) [ 20 ].…”