Managing Distal Tibial Fracture Nonunion Using Custom-Made Three-Dimensional Titanium Cage: A Rare Case Report

This case report evaluated the effectiveness of a patient-specific, three-dimensional titanium cage in achieving stable fixation and functional recovery for a complex distal tibial nonunion with extensive bone loss. A 45-year-old male, who sustained a severe nonunion due to high-energy trauma, underwent implantation of a custom-designed titanium cage, which was created using high-resolution CT imaging to ensure a precise anatomical fit. The titanium cage, in combination with a retrograde intramedullary nail and composite bone grafts, provided enhanced structural support and facilitated osseointegration. Thirteen months postoperatively, the patient exhibited minimal pain, full weight-bearing capability, and complete functional recovery. Radiographic evaluations confirmed stable fusion and effective osseointegration, restoring both limb alignment and structural integrity. This case highlights the potential of customized 3D-printed titanium cages for reconstructing significant bone defects in weight-bearing regions, offering a promising solution for complex fractures with severe bone loss by providing structural stability, biocompatibility, and improved clinical outcomes.