title: A new technique for cranioplasty with L-shaped titanium plates and combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite).
abstract: OBJECTIVE
  The use of hydroxyapatite-based ceramics for cranioplasties has recently increased in Japan, because of the good cosmetic outcomes, biocompatibility, strength, osteoconductive properties, and lack of risk of disease transmission associated with these materials. However, miniplate fixation has not been possible for ceramic implants. We describe a new technique for miniplate fixation of ceramic implants.
  
  
  METHODS
  Combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite; NGK Spark Plug Co., Aichi, Japan) were used for cranioplasties. A slot and a pair of holes were cut in each Ceratite implant, for use as a fixation unit. We have also developed a new L-shaped titanium plate (HOMS Engineering Inc., Nagano, Japan) that fits into the fixation unit. We first insert an L-shaped titanium plate through the slot from the back surface of the Ceratite implant. We then bend the plate outward at the front surface of the Ceratite implant and fix it to the cranium of the patient with titanium screws. The Ceratite implant is usually firmly fixed to the cranium of the patient with three L-shaped titanium plates.
  
  
  RESULTS
  Using L-shaped titanium plates and Ceratite implants, we successfully performed cranioplasties for seven patients with cranial defects resulting from external decompression craniotomies. The Ceratite implant exactly fit the bone window for each patient. Surgical maneuvers were simple and easy for all patients, permitting shorter operating times. All Ceratite implants were firmly fixed, and no postoperative infections have occurred.
  
  
  CONCLUSIONS
  Our new technique for cranioplasty is simple and allows rigid fixation of Ceratite implants.
authors.affiliation: Department of Neurosurgery, Osaka Medical College, Takatsuki City, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyake
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002130:Calcium Phosphates; D003399:Craniotomy / Q000295:instrumentation*; D019299:Decompression, Surgical; D005260:Female; D006408:Hematoma, Subdural / Q000601:surgery; D006801:Humans; D006882:Hydroxyapatites; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D014025:Titanium
chemical_list: D002130:Calcium Phosphates; D006882:Hydroxyapatites; C094280:hydroxyapatite-tricalciumphosphate composite; D014025:Titanium