The first case of primary metacarpal V restoration with titanium mesh and cancellous bone graft

Influence of a titanium mesh on the management of segmental long bone defects. An experimental study in a canine ulnar model

OBJECTIVES

To evaluate the influence of titanium mesh on guided bone regeneration when used, either alone or in combination with autogenous bone block graft, in a canine ulnar model.

METHODS

Thirty-two, purpose bred, adult, castrated male Beagles were used, divided into four equal-size groups. A unilateral mid-diaphyseal ulnar critical-size defect was created in each dog. The ulnar segments were stabilized with a stainless-steel plate and screws. Each defect was managed by: no further treatment (Group A) or by placement of a bone block graft taken from the ipsilateral iliac crest (Group B), or titanium mesh wrapped around the ulna (Group C), or a bone block graft and titanium mesh (Group D). After six months, bone block biopsies were performed and the samples were scanned using micro-computed tomography. Qualitative histological evaluation was performed on two non-decalcified longitudinal sections from each block.

RESULTS

No significant differences in terms of mineralized bone volume were detected between the grafted sites (Groups B and D) or between the non-grafted ones (Groups A and C). The histological evaluation indicated good integration of the bone blocks irrespective of the use of titanium mesh.

CLINICAL SIGNIFICANCE

The use of titanium mesh does not influence the amount of bone formation. The canine ulnar critical-size defect model seems to be a reliable model to use in experimental studies.

Methicillin-resistant Staphylococcus aureus infected pseudo-arthrosis of the distal tibia treated with debridement, mesh cage, autologous grafting and locking plate fixation

Infected non-union of long bones is a challenge to manage. It has a high morbidity and mortality. Treatment is very demanding and has a significant complication rate. Methicillin-resistant infected non-union has a higher morbidity and mortality compared to Methicillin-sensitive Staphylococcus aureus infection. Approximately half of all Staphylococci isolated in infected orthopaedic operations are caused by Methicillin-resistant S. aureus. We present a 42-year-old patient who had Methicillin-resistant S. aureus infected pseudo-arthrosis of the tibia that was treated with debridement, mesh cage, autologous bone-grafting, and plating of the tibia. The outcome was satisfactory despite residual limb deformity and discrepancy.