The Use of Cylindrical Titanium Mesh Cages in the Treatment of Post-Traumatic Segmental Bone Loss of the Femur

Abstract

We describe the management of a male road traffic accident victim who presented with an eleven-centimetre segmental defect of his left femur. This was treated with a cylindrical titanium mesh cage, autografted with cancellous bone and stabilised with the LISS plate system. At a two-year follow-up, radiographs showed good alignment and restoration of the limb length. Although there was formation of a good bone bridge, no osseous continuity was seen in the metal cages between the two main fragments. This treatment modality allowed attainment of immediate axial stability of the bone-implant construct, which made early weight bearing possible. In our opinion, this reconstructive technique for segmental defects in long bones is an alternative worthy of comparison with the established technique of distraction osteogenesis. The above technique may be of use in selected cases, where infection is absent.

Key words

Open fractures - defect fractures - complications of operative fracture treatment

References

• 1 Alexander R H, Proctor H J. Advanced trauma life support (ATLS) program for physicians. 5th ed. Chicago: American College of Surgeons, 1993
• 2 Allieu Y. Les transferts osseux libres vascularisés (T.O.L.V.) dans les pertes de substance osseuse des membres (P.S.O.).  Rev Chir Orthop. 1982;  68 15-21
• 3 Behrens F, Johnson J. Early bone grafting for tibial fractures.  J Orthop Trauma. 1989;  3 156-159
• 4 Chase S W, Herndon C H. The fate of autogenous and homogenous bone grafts: A historical review.  J Bone Joint Surg [Am]. 1955;  37 809-841
• 5 Christian E P, Bosse M J, Robb G. Reconstruction of large diaphyseal defects, without free fibular transfer, in grade-IIIb tibial fractures.  J Bone Joint Surg [Am]. 1989;  71 994-1004
• 6 Cmell M J, McAndrew M P, Thomas R, Schwartz H S. Structural allografts for reconstruction of lower extremity open fractures with 10 centimeters or more of acute segmental defects.  J Orthop Trauma. 1995;  9 222-226
• 7 Cobos J A, Lindsley R W, Gugala Z. The cylindrical titanium mesh cage for treatment of a long bone segmental defect: description of a new technique and report of two cases.  J Orthop Trauma. 2000;  14 54-59
• 8 Connolly J F, Guse R, Tiedeman J. Autologous marrow injection for delayed unions of the tibia.  J Orthop Trauma. 1989;  3 276-280
• 9 De- Meulemeester C, Verdonk R, Bongaerts W. The fibula pro tibia procedure in the treatment of nonunion of the tibia.  Acta Orthop Belg. 1992;  58 187-189
• 10 Freeland A E, Mutz S B. Posterior bone-grafting for infected ununited fracture of the tibia.  J Bone Joint Surg [Am]. 1976;  58 653-657
• 11 Green S A. Skeletal defects.  A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Rel Res. 1994;  301 111-117
• 12 Hunt T R, Reckling F W. Treatment of non-unions of fractures of the tibial diaphysis by posterolateral cortical cancellous bone-grafting.  Orthop Trans. 1989;  13 536-540
• 13 Ilizarov G A. Transosseous osteosynthesis. Berlin, Springer-Verlag 1992
• 14 Klemm K, Schnettler R. The use of gentamicin PMMA chains in the treatment of infected tibial nonunion.  Acta Orthop Belgica. 1992;  58 222-226
• 15 Komadina R, Smrkolj V, Baraga A. Überbrückung eines ausgedehnten Knochendefekts mit kortikospongiösen Transplantaten bei Femurfraktur durch Schussverletzung.  Unfallchirurg. 1996;  99 701-703
• 16 Levin L S. The reconstructive ladder: an orthoplastic approach.  Orthop Clin North Am. 1993;  24 393-409
• 17 Lindholm T S, Urist M R. A quantitative analysis of new bone formation by induction in composite grafts of bone marrow and bone matrix.  Clin Orthop. 1980;  150 288-300
• 18 Masquelet A. Les pseudarthroses infectées de jambe Conférences d’enseignement de la Sofcot.  Rev Chir Orthop. 1991;  40 177-188
• 19 Mathoulin C, Gilbert A, Judet H. et al . Transfert libre de péroné vascularisé dans les pseudarthroses et pertes de substance fémorale.  Rev Chir Orthop. 1993;  79 492-499
• 20 Mowlem R. Cancellous chip bone-grafts: report on 75 cases.  Lancet. 1944;  2 746-748
• 21 Paley D, Catagni M A, Argnani F. Ilizarov treatment of tibial nonunions with bone loss.  Clin Orthop. 1989;  241 146-165
• 22 Papineau L J, Alfageme A, Dalcourt J P. Ostéomyélite chronique: Excision et greffe de spongieux a l’air libre après mises a plat extensives.  Int Orthop. 1979;  3 165-176
• 23 Summer-Smith G, Schenk R K, Müller J, Willenegger H. Non-union of fractures. Bone in Clinical Orthopaedics. Stuttgart-New-York, Thieme 2002
• 24 Weber H, Cech O. Pseudarthrosis. Bern, Hans Huber Verlag 1976
• 25 Weiland A J. Vascularized free bone transplants.  J Bone Joint Surg [Am]. 1981;  63 166-169
• 26 Yaremchuk M J, Brumback R J, Manson P N. Acute and definitive management of traumatic osteocutaneous defects of the lower extremity.  Plast Reconstr Surg. 1987;  80 1-14