Deformation of a Titanium Calvarial Implant following Trauma: A Case Report

Abstract

Alloplastic material is widely used for the reconstruction of calvarial defects. The objective of this article is to describe the effect of mechanical impact on a titanium calvarial implant and to discuss mechanical properties of alternative implant materials. The patient is a 19-year-old man who was involved in a traffic accident and underwent decompressive craniectomy for an extensive subdural hematoma. Reimplantation of the skull flap was complicated by infection and the flap had to be removed. The remaining cranial defect was closed with a titanium plate. The recovery was without complications. One year later, the patient was hit on the titanium plate, during a soccer match, by the elbow of a fellow player. The implant deflected inward, leaving a visible indentation of the cranial vault. Fortunately, there were no significant neurological symptoms and radiography did not show any signs of damage or pressure on the brain parenchyma. The patient had no aesthetic complaints regarding the shape. Thus, there was no indication to remove the plate. This case illustrates the limits of the protection offered by titanium cranioplasty.

Design and Additive Manufacturing of a Biomimetic Customized Cranial Implant Based on Voronoi Diagram

“…Some researchers have tried to reduce the stress shielding effect by changing the design constructs from solid to mesh-like porous reconstruction titanium plates (Chen et al, 2006). Although the meshed plates are lighter in construct, they are prone to deformation, especially in large-sized cranial deformities (De Water et al, 2016). Besides, the mesh plates need intraoperative manual bending, and any mismatch between the implant-bone interface might result in implant failure, thereby leading to a high revision rate (De Water et al, 2016).…”

“…Although the meshed plates are lighter in construct, they are prone to deformation, especially in large-sized cranial deformities (De Water et al, 2016). Besides, the mesh plates need intraoperative manual bending, and any mismatch between the implant-bone interface might result in implant failure, thereby leading to a high revision rate (De Water et al, 2016). To overcome these problems, multiple holes/openings in the fabricated Voronoi design based PSIs replicated the feature of perforated plates.…”

Deformation of cranioplasty titanium mesh in a paediatric patient following head trauma

“…The first one was by Wiggins et al in their study of 127 custom titanium cranioplasties, where one of the patients struck himself with a metal object while he was demonstrating the strength of his titanium implant 18. The second report was by De Water et al , in which case the patient was hit on his titanium cranioplasty while playing soccer 26. Both cases did not cause any brain damage, and conservative management was favoured.…”

Decision-Making in Adult Cranial Vault Reconstruction

“…[42][43][44][45] Titanium mesh implants do not have the same strength as solid implants, and with a sufficiently strong impact, deformation of the implant is possible. 46 Implant exposure is a particularly serious complication, as this will often necessitate implant removal (Fig. 5).…”

“…42–45 Titanium mesh implants do not have the same strength as solid implants, and with a sufficiently strong impact, deformation of the implant is possible. 46…”