Osteosynthesis and Trauma Care 2004; 12(3): 108-115
DOI: 10.1055/s-2004-822777
Original Article

© Georg Thieme Verlag Stuttgart · New York

Cylindrical Titanium Mesh Cage for the Reconstruction of Long Bone Defects

R. W. Lindsey1 , Z. Gugala1
  • 1Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
Further Information

Publication History

Publication Date:
06 September 2004 (online)

Abstract

Segmental defects in long bones remain a formidable treatment challenge. Currently applied treatment modalities for long bone defects include massive cancellous autogenous bone grafting; allogenic cortical grafts; vascularized autogenous cortical bone grafts, and distraction osteogenesis. However, all these modalities possess significant inherent risks and/or limitations. Recently, a new technique utilizing a cylindrical mesh titanium cage in combination with cancellous bone grafting has been developed as an alternative. The initial clinical experience with this technique has been very encouraging. The objectives of this paper are to present the “cage technique” for reconstruction of bone defects, identify the optimal indications, describe the surgical technique, expound on its biological and biomechanical advantages, and present a series of cases that reflect the initial clinical experience with this innovative technique.

  • 1 Banic A, Hertel R. Double vascularized fibulas for reconstruction of large tibial defects.  J Reconstr Microsurg. 1993;  9 421-428
  • 2 Brown R H, Townsend G B. Segmental defects in open fractures of long bones.  Med Ann Dist Columbia. 1970;  10 555-559
  • 3 Chen Z W, Chen L E, Zhang G J, Yu H L. Treatment of tibial defect with vascularized osteocutaneous pedicled transfer of fibula.  J Reconstr Microsurg. 1986;  2 199-203
  • 4 Chmell 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
  • 5 Cierny G, Zorn K E. Segmental tibial defects. Comparing conventional and Ilizarov methodologies.  Clin Orthop. 1994;  301 118-223
  • 6 Cobos J A, Lindsey 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
  • 7 Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis.  J Bone Joint Surg [Am]. 1989;  71 1448-1468
  • 8 Green S A. Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects.  Clin Orthop. 1994;  301 111-117
  • 9 Han C S, Wood M B, Bishop A T, Cooney W P. Vascularized bone transfer.  J Bone Joint Surg [Am]. 1992;  74 1441-1449
  • 10 Hertlein H, Mittlmeier T, Piltz S, Schurmann M, Kauscke T, Lob G. Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer.  Eur Spine J. 1992;  1 131
  • 11 Hollowell J P, Vollmer D G, Wilson C R, Pintar F A, Yoganandan N. Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate?.  Spine. 1996;  21 1032-1036
  • 12 Ilizarov G A. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation.  Clin Orthop. 1989;  238 249-281
  • 13 Ilizarov G A. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction.  Clin Orthop. 1989;  239 263-285
  • 14 Johnson K D, August A, Sciadini M F, Smith C. Evaluation of ground cortical autograft as a bone graft material in a new canine bilateral segmental long bone defect model.  J Orthop Trauma. 1996;  10 28-36
  • 15 Lindsey R W, Gugala Z. The initial clinical experience with cylindrical titanium mesh cages for the treatment of segmental bone defects.  Transactions 67th AAOS Meeting. 2000;  1 503
  • 16 Lindsey R W, Gugala Z, Sun M, Chatziioannou S, Hipp J A. Cylindrical titanium mesh cage for the treatment of large segmental diaphyseal bone defects in canines.  Transactions 47th ORS Meeting. 2001;  2 990
  • 17 Lindsey R W, Gugala Z, Milne T, Latta L. Biomechanical analysis of a critical-size canine femoral segmental defect reconstructed with a titanium cage.  Transactions 50th ORS Meeting. 2004;  2 872
  • 18 Ostermann P A, Haase N, Rubberdt A, Wich M, Ekkernkamp A. Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage.  J Orthop Trauma. 2002;  16 597-601
  • 19 Rasmussen M R, Bishop A T, Wood M B. Arthrodesis of the knee with a vascularized fibular rotatory graft.  J Bone Joint Surg [Am]. 1995;  77 751-759
  • 20 Reynders P, Broos P LO, Stoffelen D. The use of cylindrical titanium mesh cages in the treatment of post-traumatic segmental bone loss of the femur.  Osteo Trauma Care. 2003;  11 99-104

Ronald W. Lindsey M. D. 

Baylor College of Medicine

6560 Fannin, Suite 1900

Houston, Texas 77030

USA

Phone: +1/7 13-9 86-56 80

Fax: +1/7 13-9 86-56 81

Email: rlindsey@bcm.tmc.edu

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