The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : CASE REPORT

Authors
Babak Otoukesh 1
Ava Parvandi 1
Mohammad Niroomand 2
Morad karimpour 3
Maryam Rahmanizadeh 3
Shayan Amiri 1
1 Department of Orthopedics Surgery, Rasool-e-Akram Hospital, School of mMedicine, Iran University of Medical Sciences, Tehran, Iran
2 Department of Orthopedics Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
10.22038/abjs.2024.83808.3812
Abstract
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.
        Level of evidence: V
Keywords
Bone defect reconstruction
Custom titanium cage
Distal tibia nonunion
Osseointegration
Tibiotalocalcaneal arthrodesis
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 1
January 2026
Pages 81-87

  • Receive Date 02 November 2024
  • Revise Date 29 December 2025
  • Accept Date 31 December 2024