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Zhang R, Gao Z, Zhu YJ, Wang XF, Wang G, He JP. Spontaneous fracture of a titanium mesh cranioplasty implant in a child: A case report. World J Clin Cases 2023; 11:1593-1599. [PMID: 36926410 PMCID: PMC10011976 DOI: 10.12998/wjcc.v11.i7.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/15/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Titanium mesh cranioplasty is often performed after decompressive craniectomy. Spontaneous fracture of the titanium prosthesis is an extremely rare postoperative complication. Here, we report a 10-year-old boy who presented with a spontaneous fracture of titanium mesh without antecedent head trauma.
CASE SUMMARY A 10-year-old boy presented with a 1-wk history of a tender bulge over the left temporo-parieto-occipital scalp. He had undergone a temporo-parieto-occipital titanium mesh cranioplasty 26 mo previously. He denied antecedent head trauma. Computerized tomography disclosed a perpendicular fissure in the titanium mesh, suggesting a diagnosis of spontaneous titanium mesh fracture. He underwent a second temporo-parieto-occipital cranioplasty and made an uneventful recovery. Three-dimensional modeling and finite element analyses were used to explore potential risk factors of titanium mesh fracture.
CONCLUSION We report a case of spontaneous fracture of a titanium mesh cranioplasty implant. The current case and literature review indicate that titanium mesh implants should be well-anchored to the base of bony defects to prevent fatigue-induced fractures.
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Affiliation(s)
- Rui Zhang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Zhe Gao
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Yong-Jie Zhu
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Xin-Fa Wang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Gang Wang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Jun-Ping He
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
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Lewin S, Åberg J, Neuhaus D, Engqvist H, Ferguson SJ, Öhman-Mägi C, Helgason B, Persson C. Mechanical behaviour of composite calcium phosphate-titanium cranial implants: Effects of loading rate and design. J Mech Behav Biomed Mater 2020; 104:103701. [PMID: 32174441 DOI: 10.1016/j.jmbbm.2020.103701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
Cranial implants are used to repair bone defects following neurosurgery or trauma. At present, there is a lack of data on their mechanical response, particularly in impact loading. The aim of the present study was to assess the mechanical response of a recently developed composite calcium phosphate-titanium (CaP-Ti) implant at quasi-static and impact loading rates. Two different designs were tested, referred to as Design 1 (D1) and Design 2 (D2). The titanium structures in the implant specimens were additively manufactured by a powder-bed fusion process and subsequently embedded in a self-setting CaP material. D1 was conceptually representative of the clinically used implants. In D2, the titanium structure was simplified in terms of geometry in order to facilitate the manufacturing. The mechanical response of the implants was evaluated in quasi-static compression, and in impact using a drop-tower. Similar peak loads were obtained for the two designs, at the two loading rates: 808 ± 29 N and 852 ± 34 for D1, and 840 ± 40 N and 814 ± 13 for D2. A strain rate dependency was demonstrated for both designs, with a higher stiffness in the impact test. Furthermore, the titanium in the implant fractured in the quasi-static test (to failure) but not in the impact test (to 5.75 J) for D1. For D2, the displacement at peak load was significantly lower in the impact test than in the quasi-static test. The main difference between the designs was seen in the quasi-static test results where the deformation zones, i.e. notches in the titanium structure between the CaP tiles, in D1 likely resulted in a localization of the deformation, compared to in D2 (which did not have deformation zones). In the impact test, the only significant difference between the designs was a higher maximum displacement of D2 than of D1. In comparison with other reported mechanical tests on osteoconductive ceramic-based cranial implants, the CaP-Ti implant demonstrates the highest reported strength in quasi-static compression. In conclusion, the titanium structure seems to make the CaP-Ti implant capable of cerebral protection in impact situations like the one tested in this study.
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Affiliation(s)
- Susanne Lewin
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden.
| | - Jonas Åberg
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Engqvist
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Caroline Öhman-Mägi
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Persson
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
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Iaccarino C, Kolias AG, Roumy LG, Fountas K, Adeleye AO. Cranioplasty Following Decompressive Craniectomy. Front Neurol 2020; 10:1357. [PMID: 32063880 PMCID: PMC7000464 DOI: 10.3389/fneur.2019.01357] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery Unit, University Hospital of Parma, Parma, Italy.,Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Louis-Georges Roumy
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Amos Olufemi Adeleye
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurological Surgery, Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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van de Vijfeijken SE, Münker TJ, de Jager N, Vandertop WP, Becking AG, Kleverlaan CJ, Becking A, Dubois L, Karssemakers L, Milstein D, van de Vijfeijken S, Depauw P, Hoefnagels F, Vandertop W, Kleverlaan C, Münker T, Maal T, Nout E, Riool M, Zaat S. Properties of an In Vivo Fractured Poly(Methyl Methacrylate) Cranioplasty After 15 Years. World Neurosurg 2019; 123:e60-e68. [DOI: 10.1016/j.wneu.2018.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/16/2022]
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Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review. World Neurosurg 2018; 117:443-452.e8. [DOI: 10.1016/j.wneu.2018.05.193] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/19/2022]
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