The patient was a 34-year-old male who had suffered a fracture of the tibial shaft due to a severe accident. The fracture was immediately controlled with a plate, but due to infection, the plate was removed and an external fixator was placed. A 12-cm bone debridement was performed and cement was placed.

Physician profile

Dr. Mohammad Hosein Nabian

• Orthopedic Foot and ankle and pediatric Surgeon
• Assistant Professor of Orthopedic Surgery at Shariati Hospital
• Tehran University of Medical Sciences (TUMS)

Pre-operative Planning

A CT scan of the tibia bone on both sides with a thickness of 1 mm was taken. First, a 3D model of the bone and cement was obtained, and by analyzing the extent of the defect and the opposite limb, the height of the prosthesis was determined to prevent limb shortening. The diameter of the nail slot was considered in the design in accordance with the maximum nail diameter available in medical equipment companies and the diameter of the bone canal.

The prosthesis was made using a 3D printer and, after post-processing, washing, and sterilization with gamma rays, was provided to the physician.

Surgical Treatment

The patient was under spinal anesthesia, first the cement was removed, then the proximal and distal bone canals were rimmed, and according to the length of the designed prosthesis, the distal shaft was stretched and 5 mm was cut from the proximal and distal parts of the bone. Then the prosthesis was filled with prepared bone grafts and placed in the appropriate place, and finally the nail was placed.

Post-operative Follow-up

During the follow-ups, the patient’s pain decreased over time and the patient started walking easily after putting away the crutches and is satisfied. In the radiology image, signs of bone fusion were observed in the proximal and distal parts of the prosthesis and the alignment of the foot is also good and normal.

Physician’s Conclusion

Bone shaft reconstruction prostheses are suitable for patients who suffer from bone fractures. After controlling the infection with cement, after three months, these types of prostheses are surgically placed in the bone defect area and the patient can start walking and loading on the prosthesis the day after surgery.

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Tibial Nonunion in a 34-Year-Old Patient | Dr. Mohammad Hosein Nabian