title: Management of Distal Tibial Metaphyseal Bone Defects With an Intramedullary Nitinol Scaffold: A Novel Technique.
abstract: Difficult problems that are faced when reconstructing severe pilon fractures include filling metaphyseal defects and supporting an impacted, multifragmented articular surface. Supplements to plate fixation currently available in a surgeon's armamentarium include cancellous bone autograft, structural bone allograft, demineralized bone matrix, and calcium-based cements. Cancellous autograft possesses limited inherent mechanical stability and is associated with graft site morbidity. Structural allografts incorporate inconsistently and are plagued by late resorption. Demineralized bone matrix also lacks inherent structural stability. Calcium phosphate cements are not rigidly fixed to bone unless fixation is applied from cortical bone or through a plate, which must be taken into consideration when planning fixation. The Conventus DRS (Conventus Orthopaedics, Maple Grove, MN) implant is an expandable nitinol scaffold that takes advantage of the elasticity and shape memory of nitinol alloy. Once deployed and locked, it serves as a stable intramedullary base for fragment-specific periarticular fracture fixation, even in the face of metaphyseal bone loss. Two cases of successful implant use are presented. In both cases, the implant is used to fill a metaphyseal void and provide stable articular support to the distal tibial plafond.
  
  
  METHODS
  Therapeutic Level V: Case Report, Expert Opinion.
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina (SEF).|OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina (JKE).
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Ford
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina (SEF).|OrthoCarolina Foot & Ankle Institute, Charlotte, North Carolina (JKE).
authors.forename: J Kent
authors.initials: JK
authors.lastname: Ellington
mesh_terms: D000497:Alloys; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000601:surgery*
chemical_list: D000497:Alloys; C013616:nitinol
keywords: bone defect; distal tibia; nitinol; pilon; plafond