Custom-Made Implants in Ankle Bone Loss: A Retrospective Assessment of Reconstruction/Arthrodesis in Sequelae of Septic Non-Union of the Tibial Pilon

Abstract

Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments. Materials and Methods: Above all, 3D printing allows for the customization of implants based on the anatomy of each patient, using a personalized process through the layer-by-layer deposition of materials. Results: This article presents different cases from the authors’ experience. Specifically, four patients suffered tibia and ankle fractures and after radical surgery for chronic osteomyelitis combined with high-performance antibiotic therapy underwent ankle reconstruction/arthrodesis with custom-made tibial spacers. Conclusions: Thanks to 3D-printed patient-specific devices, it is possible to perform surgical procedures that, for anatomical reasons, would have been impossible otherwise. Moreover, an improvement in overall functionality and an important reduction in pain were shown in the last follow-up in all patients.

A Combination of Ilizarov Frame, Externalized Locking Plate and Tibia Bridging for an Adult with Large Tibial Defect and Severe Varus Deformity Due to Chronic Osteomyelitis in Childhood: A Case Report

“…However, the stigma after amputation could be prominent, and the young adult rejected this treatment decidedly. (2) Limb salvage surgery with custom-made implants to reconstruct the joint: A custom-made prosthetic from 3-D printing technology is a feasible choice for patients with severely destructed anatomical structures [ 12 ], but the severe LLD of this patient makes a custom-made implant unsuitable. (3) Limb salvage surgery with bone lengthening and tibial bridging: Autograft is not a feasible choice when the bone defect is more than 6–8 cm.…”

In Vivo Foot Segmental Motion and Coupling Analysis during Midterm Follow-Up after the Open Reduction Internal Fixation of Trimalleolar Fractures

“…When comparing the patients' affected side to the contralateral non-affected side, some differences were obvious. The changes observed in the ankle segment during the loading response and the pre-swing phase can be a result of possible arthritis and arthro-fibrosis of the ankle joint and fibro-adhesions (i.e., muscle adhesions) due to surgery, which all affect ankle joint mobility [7][8][9][10]. Additionally, the involvement of pain at the affected foot may also contribute to the reduced ROM seen during the loading response and the pre-swing phase.…”

“…TAFs and subsequent plate osteosynthesis are associated with osteoarthritis, arthrofibrosis, and fibro-adhesions (i.e., flexor hallucis longus and peroneal muscles), leading to restriction in ankle joint mobility [7][8][9][10]. Subsequently, alterations in foot joint mobility, segment coupling (kinematic relationship between adjacent foot segments), and kinetics (forces acting on the foot joints) during gait may occur as well.…”

Surgical Outcomes and Complications of Custom-Made Prostheses in Upper Limb Oncological Reconstruction: A Systematic Review

“…Therefore, a customized approach is always necessary to evaluate and study each case effectively. Computer-assisted technology is playing an increasingly important role in surgery for musculoskeletal tumors, including pre-operative planning, intraoperative computer navigation for accurate identification of the extent of the tumor, and precise fitting of custom-made prostheses [ 5 , 6 , 7 ]. Computer-aided design and computer-aided manufacturing (CAD-CAM) offer a new approach to designing custom-made implants [ 8 , 9 ].…”