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Osteosynthesis and Trauma Care 2003; 11(2): 99-104
DOI: 10.1055/s-2003-42524
Case Report

© Georg Thieme Verlag Stuttgart · New York

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

P. Reynders1 , P. L. O. Broos1 , D. Stoffelen1
  • 1Department of Traumatology, U.Z. Gasthuisberg, Leuven, Belgium
Further Information

Publication History

Publication Date:
06 October 2003 (online)

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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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 3 Behrens F, Johnson J. Early bone grafting for tibial fractures.  J Orthop Trauma. 1989;  3 156-159
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Connolly J F, Guse R, Tiedeman J. Autologous marrow injection for delayed unions of the tibia.  J Orthop Trauma. 1989;  3 276-280
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 13 Ilizarov G A. Transosseous osteosynthesis. Berlin, Springer-Verlag 1992
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Komadina R, Smrkolj V, Baraga A. Überbrückung eines ausgedehnten Knochendefekts mit kortikospongiösen Transplantaten bei Femurfraktur durch Schussverletzung.  Unfallchirurg. 1996;  99 701-703
    CrossrefPubMedGoogle Scholar
  • 16 Levin L S. The reconstructive ladder: an orthoplastic approach.  Orthop Clin North Am. 1993;  24 393-409
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 18 Masquelet A. Les pseudarthroses infectées de jambe Conférences d’enseignement de la Sofcot.  Rev Chir Orthop. 1991;  40 177-188
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 20 Mowlem R. Cancellous chip bone-grafts: report on 75 cases.  Lancet. 1944;  2 746-748
    PubMedGoogle Scholar
  • 21 Paley D, Catagni M A, Argnani F. Ilizarov treatment of tibial nonunions with bone loss.  Clin Orthop. 1989;  241 146-165
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 23 Summer-Smith G, Schenk R K, Müller J, Willenegger H. Non-union of fractures. Bone in Clinical Orthopaedics. Stuttgart-New-York, Thieme 2002
    Google Scholar
  • 24 Weber H, Cech O. Pseudarthrosis. Bern, Hans Huber Verlag 1976
    Google Scholar
  • 25 Weiland A J. Vascularized free bone transplants.  J Bone Joint Surg [Am]. 1981;  63 166-169
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Prof. Dr. P. Reynders

Department of Traumatology · U. Z. Gasthuisberg

Herestraat 49

3000 Leuven · Belgium

Phone: +32/16 34 42 77

Fax: +32/16 34 46 14

Email: peter.reynders@uz.kuleuven.ac.be