Biomechanical Evaluation of the Cylindrical
Titanium Mesh Cage for the Treatment
of Segmental Defects of the Tibia

Abstract

The combination of a cylindrical titanium mesh cage with an intramedullary nail is a new technique in the management of long segmental bony defects. Clinical case report studies have shown the significant advantages of this method, like immediate full weight bearing and early functional recovery of the involved extremity. A biomechanical investigation of this construct showed its high stability. Load to failure tests resulted in bone breakage. There was no hardware failure. Neither the nail, the locking bolts nor the cage broke or were deformed. Also, precompression of the cage resulted in a statistically significant higher stiffness of the construct using the nail with the cylindrical titanium mesh cage. Therefore, a compression nail is recommended in the clinical use of this technique when significant segmental bony defects are reconstructed.

Cylindrical titanium mesh cage - interlocking nail - tibial segmental defect - biomechanical tests - precompression

References

• 1 Boccardi R W, Ross S E, Pedotti A, Rodano R, Santabrogio G. Evaluation of muscular moments at the lower limb joints by an online processing of kinematic data and ground reaction.  J Biom. 1981;  14 35
• 2 Cierny G, Zorn K E. Segmental tibial defects. Comparing conventional and Ilizarov methodologies.  Clin Orthop Rel Res. 1994;  301 118-123
• 3 Cobos J A, Lindsay 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 45-59
• 4 Dahl M T, Gulli B, Berg T. Complications of limb lengthening: a learning curve.  Clin Orthop. 1994;  301 10-18
• 5 Georgiades G M, De Silva S P. Reconstruction of skeletal defects in the forearm after trauma: treatment with cement spacer and delayed cancellous bone grafting.  J Trauma. 1995;  38 910-914
• 6 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
• 7 Hertel R, Pisan M. Jakob RP. Use of the ipsilateral vascularised fibula for tibial reconstruction.  J Bone Joint Surg [Br]. 1995;  77 914-919
• 8 Lindsey R W, Miclau T, Probe R, Perren S. A defect in continuity in the canine femur: an in vivo experimental model for the study of bone graft incorporation.  Yale J Biol Med. 1993;  66 157-163
• 9 Morrison J B. Mechanics of the knee in normal walking.  J Biom. 1970;  10 569
• 10 Nagger L, Chevalley F, Blanc C H, Livio J J. Treatment of large bone defects with the Ilizarov technique.  J Trauma. 1993;  34 390-393
• 11 Ostermann P AW, Haase N, Rübberdt 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;  16 597-607
• 12 Prokuski L J, Marsh J L. Segmental bone deficiency after acute trauma. The role of bone transport.  Orthop Clin North Am. 1994;  25 753-763
• 13 Stolze D, Harms J. Correction of posttraumatic deformities: principles and methods.  Orthopäde. 1999;  28 731-745
• 14 Wright R. Action of the ankle and subtalar joint complex.  J Bone Joint Surg [Am]. 1964;  46 361