The patient was a 43-year-old man facing nonunion of femur’s bone midshaft after numerous surgeries. During the surgery the bone necrosis were removed and at the same time femoral nail and cement were placed at the defect site.
Physician profile
Dr. Seyyed Hadi Kalantar
- Orthopedic Trauma Surgeon
- Assistant Professor of Orthopedic and Trauma Surgery
- Tehran University of Medical Sciences (TUMS)
Pre-operative Planning
In order to generate a 3D model of the bone CT Scan imaging was done with 1 mm thickness of slices of both femoral bones. The 3D model of bones, the cement and the nail were generated and the measure of defect calculated which was equal to 13 cm. the diameter of the nail’s location was designed adequate to the previous placed nail with 6 screw places and 4 morse taper pegs. In order to prevent the prosthesis rotation two flanges were designed in the proximal and distal of the lateral part.
The implant was printed with 3D printers and after processing, washing and sterilization with Gama rays was provided to the doctor.
Surgical Treatment
The patient went under spinal anesthesia. At first the cement was removed and then the necrosis of bones at the defect site were removed. At first the anterior and the posterior part were connected using the designed pegs around the nail at the defect site and the screws were closed. At the end the 4.5 mm screws were located on their designed places on the flanges.
Extracted Bone Cement from the Tibial Shaft
Post-operative Follow-up
Physician’s Conclusion
In patients with nonunion in bone’s shaft in order to provide a primary stability, nail and cement can be used at the nonunion site and after 3 month, the reconstruction bone’s shaft prosthesis can be used around the nail at the defect’s site.
As the privileges of customized implants sing the CT Scan imaging, design is based on the bone’s geometry and the implanted nail, the length of the defect and the required length in order to reach the proper fixation and stability.