Treatment of calvarial defects by resorbable and non-resorbable sonic activated polymer pins and mouldable titanium mesh in two dogs: a case report

Abstract

BackgroundTo date, calvarial defects in dogs have traditionally been addressed with different types of implants including bone allograft, polymethylmethacrylate and titanium mesh secured with conventional metallic fixation methods. This report describes the use of an absorbable and non absorbable novel polymer fixation method, Bonewelding® technology, in combination with titanium mesh for the repair of calvarial defects in two dogs. The clinical outcomes and comparative complication using resorbable and non-resorbable thermoplastic pins were compared.Case presentationThis report of two cases documents the repair of a traumatic calvarial fracture in an adult male Greyhound and a cranioplasty following frontal bone tumor resection in an adult female Cavalier King Charles Spaniel with the use of a commercially available titanium mesh secured with an innovative thermoplastic polymer screw system (Bonewelding®). The treatment combination aimed to restore cranial structure, sinus integrity and cosmetic appearance. A mouldable titanium mesh was cut to fit the bone defect of the frontal bone and secured with either resorbable or non-resorbable polymer pins using Bonewelding® technology. Gentamycin-impregnated collagen sponge was used intraoperatively to assist with sealing of the frontal sinuses. Calvarial fracture and post-operative implant positioning were advised using computed tomography. A satisfactory restoration of skull integrity and cosmetic result was achieved, and long term clinical outcome was deemed clinically adequate with good patient quality of life. Postoperative complications including rostral mesh uplift with minor associated clinical signs were encountered when resorbable pins were used. No postoperative complications were experienced in non-resorbable pins at 7 months follow-up, by contrast mesh uplift was noted 3 weeks post-procedure in the case treated using absorbable pins.ConclusionsThe report demonstrates the innovative use of sonic-activated polymer pins (Bonewelding® technology) alongside titanium mesh is a suitable alternative technique for skull defect repair in dogs. The use of Bonewelding® may offer advantages in reduction of surgical time. Further, ultrasonic pin application may be less invasive than alternative metallic fixation and potentially reduces bone trauma. Polymer systems may offer enhanced mesh-bone integration when compared to traditional metallic implants. The use of polymer pins demonstrates initial potential as a fixation method in cranioplasty. Initial findings in a single case comparison indicate a possible advantage in the use of non-absorbable over the absorbable systems to circumvent complications associated with variable polymer degradation, further long term studies with higher patient numbers are required before reliable conclusions can be made.

Application of a bilateral temporal fascia free graft in a dog with multifragmented frontal sinus and nasal bone fracture

“…The anterior part of the sinus of the dog in this report was displaced 5 to 10 mm depending of the fragments, which causing severe esthetic deficits, which led the authors to consider reconstruction 21 . The most commonly used implants in dogs for reconstruction are plates, titanium mesh and cerclage wires 6–13 . Cerclage wires were mostly used in the 1980s in human medicine and then introduced in veterinary medicine and has been associated with good esthetic outcomes and functionality 26 .…”

“…No guidelines have been established for sinus and nasal bone reconstruction in small animals. Instead, evidence is limited to case reports of surgical treatments relying on bone allografts, resorbable and nonresorbable sonic‐activated polymer pins, titanium mesh, different types of bone cements, synthetic polymethylmethacrylate (PMMA), cerclage wires or plates and screws 6–13 . All these implants act as a nidus for infection in open fractures, exposed to the natural frontal sinus and nasal flora 14,15 .…”

Titanium mesh osteosynthesis for the treatment of severely comminuted maxillofacial fractures in four dogs

“…Medical databases (Medline, Ovid, Science direct) were searched with the keywords maxillofacial/ fracture/dog/titanium mesh in April 2021. The use of titanium mesh for the treatment of a traumatic calvarial fracture has been published in the veterinary literature in only one case report (Langer et al 2018). In this case, the titanium mesh was secured to the bone with thermoplastic resorbable polymer pins.…”

Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb

“…This technology was already used in the surgical treatment of hallux valgus [ 17 ], in calvarial defects in dogs together with a titanium mesh [ 18 ], in oral and maxillofacial surgery [ 19 ], in experimental spinal surgery in sheep [ 20 ] and can potentially be used in rotator cuff repair [ 21 ].…”