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. 2022 May:94:107057.
doi: 10.1016/j.ijscr.2022.107057. Epub 2022 Apr 13.

Repair of distal fibular and lateral malleolus defects with individualized 3D-printed titanium alloy prosthesis: The first case report from China

Jiangang Cheng  1 , Yang Gao  1 , Zhuoyu Long  2 , Guoxian Pei  1 , Zhengyu Li  3 , Guolin Meng  4
Affiliations

Repair of distal fibular and lateral malleolus defects with individualized 3D-printed titanium alloy prosthesis: The first case report from China

Jiangang Cheng et al. Int J Surg Case Rep. 2022 May.

Abstract

Introduction and importance: This case report describes the reconstruction of the traumatic distal fibular and lateral malleolus defects with a novel method of using individualized 3D printed titanium prosthesis for the first time.

Case presentation: A 63-year-old male farmer was hospitalized in emergency because of open injury and distal fibular and lateral malleolus defects in the left leg caused by a car accident. 3 months after debridement and latissimus dorsi muscle flap transplantation and skin graft operation, the patient re-hospitalized because of distal fibular and lateral malleolus defect and local pain. We examined the bilateral ankle joint with three-dimensional CT, obtained data about the missing left distal fibular and lateral malleolus through the mirror principle. The corresponding titanium alloy prosthesis then was designed and printed using a 3D metal printer. The patient had no obvious contraindication for surgery, so the prosthesis was surgically implanted. The patient was followed up for 2 years. There was no discomfort at the surgical site. The function of the operated ankle was satisfied by the patient, the AOFAS (American Orthopaedic Foot & Ankle Society) score was 85 (Kitaoka et al., 1994 [1]).

Clinical discussion: Individualized 3D printed titanium alloy prosthesis consistent with the anatomical structure of lost distal fibula and lateral malleolus. The proximal end of the prosthesis was designed with four nail holes to install screws to fix the fibula together with it. The lower tibiofibular and talofibular joint surfaces of the prosthesis were designed smoothly. In order to improve the stability of the lower tibiofibular joint, anchors were placed at the attachment of the anterior and posterior tibiofibular ligaments to reconstruct these ligaments.

Conclusion: The structure and function of the reconstructed distal fibular and the lateral malleous were close to normal. Individualized 3D printed prosthesis might have considerable advantages over traditional treatment methods. The individualized 3D printed titanium alloy prosthesis provides a new method for the repair and reconstruction of similar bone defects. The use of 3D printed prosthesis for surgical repair needs to be further examined in the future through long-term follow-up studies and in more cases.

Keywords: 3D printed; Case report; Defect; Distal fibular; Lateral malleolus; Prosthesis; Titanium alloy.

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Conflict of interest statement

None of the authors have any conflicts of interest.

Figures

Fig. 1
Fig. 1
Preoperative antero-posterior (A) and lateral radiographs (B) of the patient. The radiographs show that the distal fibula and lateral malleolus are defective, but the alignment of the distal tibia fracture was good.
Fig. 2
Fig. 2
Preoperative functional appearance of the affected ankle (A and B). Ankle dorsiflexion and plantar flexion were partially limited.
Fig. 3
Fig. 3
External (A and B), front (C), and lateral view (D) of the design of the 3D printed prosthesis. The 3D-printed prosthesis matched the distal fibula and lateral malleolus precisely.
Fig. 4
Fig. 4
Anteroposterior (A) and lateral (B) radiographs 2-years post-operation. The images indicate that the lower tibiofibular screw was broken, but the 3D-printed prosthesis was not loose.
Fig. 5
Fig. 5
Functional appearance of the affected ankle 2-years post-operation. Ankle flexion (A) and extension (B) were close to normal.
See this image and copyright information in PMC

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