title: Patient-Specific 3-Dimensional Printed Titanium Truss Cage With Tibiotalocalcaneal Arthrodesis for Salvage of Persistent Distal Tibia Nonunion.
abstract: Management of large structural defects of the ankle and hindfoot is challenging with modest outcomes in the literature. Tibiotalocalcaneal (TTC) arthrodesis using a retrograde intramedullary nail has been used for the treatment of talar avascular necrosis, severe tibial plafond fractures, ankle and hindfoot nonunions, Charcot arthropathy, and failed total ankle arthroplasty. External fixators and spatial frames provide robust multiplanar correction of deformity, but little is known in the literature regarding the salvage treatment of persistent nonunion refractory to frame treatment. In this report, we present the case of an open tibial plafond fracture with nonunion despite 1 year of fixator and frame management that was successfully treated using a patient-specific 3-dimensional printed titanium truss cage in combination with a retrograde TTC nail. At most recent 1-year follow-up, the patient had minimal pain, no wound complications, and was able to ambulate and work independently without an assistive device for the first time in 2 years since his original injury. The case presented here serves as a proof of principle that requires future research to determine its long-term clinical benefits, cost-effectiveness, and complications.
  
  
  METHODS
  Level V: Expert Opinion.
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina andyhsu1@gmail.com.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina.
authors.forename: J Kent
authors.initials: JK
authors.lastname: Ellington
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation*; D001858:Bone Nails; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D066330:Printing, Three-Dimensional; D019736:Prostheses and Implants; D011859:Radiography; D016879:Salvage Therapy; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000601:surgery*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014025:Titanium
chemical_list: D014025:Titanium
keywords: 3D printing; custom cage; patient-specific implants; roughened titanium; truss design