Aims

This study reviews the use of a titanium mesh cage (TMC) as an adjunct to intramedullary nail or plate reconstruction of an extra-articular segmental long bone defect.

Purpose: To assess the treatment results of long segmental bone defects using cylindrical titanium mesh cages.

Methods: A case series of six patients who sustained open Gustilo Anderson Type IIIB Tibia, Femur, and Humerus fractures, associated with extensive segmental bone and soft tissue loss. The patients were initially treated with serial wound irrigations, debridements, and external fixation. After the soft tissue envelope was successfully reconstructed by the Plastic Surgery Service, the large segmental bone defects were reconstructed with cylindrical titanium mesh cages packed with a composite of cancellous allograft and demineralized bone matrix putty, and stabilized with statically locked intra-medullary nails, or plates.

Results: The mean segmental bone loss was 9.2 cm (range: 7–13), and all patients had a minimum of one year follow-up. At one year post reconstruction, radiographs demonstrated stable, well aligned, and healed constructs, and computed tomography images confirmed the presence of bony in-growth through out the cages. All patients were able to full weight-bear ambulate, and all achieved good range of motion of the affected extremity, except for two patient that suffered drop foot, as a result of the index injury.

Conclusion: This technique appears to be a reasonable alternative in the treatment of large segmental bone defects of the Tibia.

We created virtual three-dimensional reconstruction models from computed tomography scans obtained from patients with acetabular fractures. Virtual cylindrical implants were placed intraosseously in the anterior column, the posterior column and across the dome of the acetabulum. The maximum diameter which was entirely contained within the bone was determined for each position of the screw. In the same model, the cross-sectional diameters of the columns were measured and compared to the maximum diameter of the corresponding virtual implant.

We found that the mean maximum diameter of virtual implant accommodated by the anterior columns was 6.4 mm and that the smallest diameter of the columns was larger than the maximum diameter of the equivalent virtual implant.

This study suggests that the size of the screw used for percutaneous fixation of acetabular fractures should not be based solely on the measurement of cross-sectional diameter and that virtual three-dimensional reconstructions might be useful in pre-operative planning.