Patient-Specific 3-Dimensional Printed Titanium Truss Cage With Tibiotalocalcaneal Arthrodesis for Salvage of Persistent Distal Tibia Nonunion.
UNLABELLED
Management of large structural defects of the ankle and hindfoot is challenging with modest outcomes in the literature. Tibiotalocalcaneal (TTC) arthrodesis using a retrograde intramedullary nail has been used for the treatment of talar avascular necrosis, severe tibial plafond fractures, ankle and hindfoot nonunions, Charcot arthropathy, and failed total ankle arthroplasty. External fixators and spatial frames provide robust multiplanar correction of deformity, but little is known in the literature regarding the salvage treatment of persistent nonunion refractory to frame treatment. In this report, we present the case of an open tibial plafond fracture with nonunion despite 1 year of fixator and frame management that was successfully treated using a patient-specific 3-dimensional printed titanium truss cage in combination with a retrograde TTC nail. At most recent 1-year follow-up, the patient had minimal pain, no wound complications, and was able to ambulate and work independently without an assistive device for the first time in 2 years since his original injury. The case presented here serves as a proof of principle that requires future research to determine its long-term clinical benefits, cost-effectiveness, and complications.


LEVEL OF EVIDENCE
Level V: Expert Opinion.
['Hsu|Andrew R|AR|', 'Ellington|J Kent|JK|']
D000843:Ankle Joint D001174:Arthrodesis D001858:Bone Nails D005599:Fractures, Ununited D006801:Humans D008297:Male D008875:Middle Aged D066330:Printing, Three-Dimensional D019736:Prostheses and Implants D011859:Radiography D016879:Salvage Therapy D013640:Tarsal Joints D013978:Tibial Fractures D014025:Titanium
3D printing custom cage patient-specific implants roughened titanium truss design