Surgical Planning and 3D-Printed Mesh Implant for Effective Bone Gap Management: A Case Report

Critical-size bone defects in distal tibial open wounds pose a formidable challenge, requiring interventions that can address osseous reconstruction with less number of surgeries. Current treatment modalities may fall short in achieving optimal outcomes, with respect to early weight bearing due to the inability of the graft to sustain weight, graft-related infections, non-union in large defects, donor site morbidity, and non-availability of bone grafts due to earlier harvest. This case report explores the potential application of a 3D-printed mesh implant to this complex clinical scenario.

A 38-year-old male, post-road traffic accident, presented with an inability to walk due to fractures of the medial malleolus and distal tibia-fibula with a grade 3b open wound. Initial treatment was done with an external fixator and fibula plating, with the fixator removed after 5 months. The fracture showed atrophic non-union and a 2.5 cm limb shortening at the end of 5 months. Preferring thick flap incisions, the patient operated with a 3D-printed titanium mesh implant with a plate construct. Post-surgery, we followed a non-weight-bearing regime for 1.5 months, progressing to full weight-bearing by 3 months. At 1.5 years, CT scans confirmed good bone integration and ambulation restoration.

The use of 3D-printed mesh implants may be a viable option for managing critical-size bone defects in distal tibial open wounds. Porotic nature of mesh implant facilitates bone ingrowth in large gaps.