The patient was a young male who had sustained a right tibial shaft fracture following a traumatic injury. He had undergone multiple surgical procedures; however, all previous interventions failed to achieve successful fracture union. Consequently, persistent nonunion resulted in the formation of a large segmental defect within the tibial diaphysis. Due to the extent of bone loss and repeated treatment failures, the patient had become a candidate for lower-limb amputation.
Physician profile
Dr. Abolfazl Bagheri Fard
- Orthopedic Surgeon, Fellowship-Trained in Knee Surgery
- Professor of Orthopedic Surgery, Knee Surgery and Sports Medicine
- Iran University of Medical Sciences
- (Shafa Yahyaeian Hospital)
Pre-operative Planning
Computed tomography (CT) scans of both tibiae were obtained with a slice thickness of 1 mm. Three-dimensional reconstruction and segmentation of the bony structures were subsequently performed. Detailed analysis of the three-dimensional models demonstrated a segmental bone defect measuring approximately 180 mm.
To reconstruct the defect, a patient-specific tibial shaft reconstruction mesh cage was designed. To facilitate surgical implantation and improve intraoperative handling, the implant was developed as a modular construct. The final design consisted of two mesh cage components, each measuring 90 mm in height. For fixation, an intramedullary tibial nail was selected, and the optimal nail diameter and length were determined during the preoperative planning process.
The implants were manufactured using additive manufacturing technology from medical-grade titanium alloy. Following post-processing, cleaning, and sterilization using gamma irradiation, the implants were delivered for surgical use.
Surgical Treatment
The patient went under spinal anesthesia. At first the cement was removed and after preparing the distal and proximal bones at first the anterior part and then the posterior at of the prosthesis were located firmly around the nail and fixed by closing the screws. Eventually the porosity of the prosthesis was filled with prepared grafts.
Post-operative Follow-up
Postoperative radiographic assessment confirmed satisfactory positioning of the reconstruction cage and stable fixation of the tibia. Clinical and radiological evaluations demonstrated successful restoration of the segmental defect and preservation of the affected limb.
The treating surgeon expressed satisfaction with the reconstruction outcome. Most importantly, limb salvage was successfully achieved, thereby eliminating the need for amputation.
Physician’s Conclusion
One of the principal advantages of patient-specific implants is their ability to be designed according to the unique anatomical characteristics, defect morphology, and clinical requirements of each individual patient. Advanced preoperative simulation and customized implant design enable accurate reconstruction of complex bone defects while optimizing implant fit and function.
Tibial shaft reconstruction prostheses and mesh cages can be effectively utilized in patients presenting with nonunion of long-bone shafts. In addition to serving as a scaffold for new bone formation and biological integration, these implants provide immediate structural stability. Consequently, patients may begin protected ambulation with crutch assistance as early as the first postoperative day, facilitating early rehabilitation and functional recovery.
Download Case Report (PDF)
Tibial Shaft Nonunion with Diaphyseal Reconstruction Cage | Dr. Abolfazl Bagheri Fard