title: Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report.
abstract: This is a case report of a patient who sustained multiple gunshots resulting in a Gustilo Anderson type IIIB mid-shaft humeral fracture associated with extensive segmental bone and soft-tissue loss. The patient was treated initially by multiple irrigations, wound debridement, and a unilateral external fixator. After the soft tissue healed without infection, the mid-shaft humeral defect of approximately 8 cm segmental bone loss was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with limited contact dynamic compression plates. At 13 months follow-up, plain radiographs demonstrated a healed construct with good alignment, and computed tomography images demonstrated bony in-growth through the cage. The patient had full range of motion at the shoulder and the elbow. This technique may be a reasonable alternative when treating large segmental bone defects of the humerus.
authors.affiliation: Department of Orthopedic Surgery, Phoenix Orthopedic Residency Program, Phoenix, AZ 85006, USA. n_attias@medprodoctors.com
authors.forename: Naftaly
authors.initials: N
authors.lastname: Attias
authors.forename: Richard E
authors.initials: RE
authors.lastname: Lehman
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Bodell
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Lindsey
mesh_terms: D000328:Adult; D001860:Bone Plates; D004867:Equipment Design; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011859:Radiography; D013526:Surgical Mesh; D014025:Titanium; D014184:Transplantation, Homologous; D014948:Wounds, Gunshot / Q000601:surgery*
chemical_list: D014025:Titanium