“Bone-mesh”: Combined fractured bone and titanium mesh for primary reconstruction of compound skull fractures

Abstract

Problem considered

Skull fractures account for a large number of traumatic brain injuries and these injuries warrant urgent medical attention. Their variety in location, the magnitude of intra-cranial injuries, and a fairly cautious approach to reconstruct primarily have led to a lack in consensus in the management of these injuries. The long standing practice of removal of bone is giving way to single stage repair. The aim of the study was to analyze the benefits and adverse effects of primary reconstruction of skull using combination of the fractured fragments of bone and titanium mesh as the cranioplasty material.

Methods

Patients with compound fractures of skull, between the ages of 18–65years, were planned for primary reconstruction with fractured bone fragments and titanium mesh after dealing with the intra-cranial lesion. Patients were observed daily for clinical signs of infections and alternate day lab checks (WBC counts) were performed. Post-operative CT scans with 3-diamensional skull reconstruction was obtained before discharge and assessment of cosmetic results were done.

Results

Eleven male (mean age 32.63 ± 10.87 years) patients underwent primary reconstruction of compound skull fractures. The mean interval between injury and operation was 62.2 ± 21 h. The mean duration of surgery was 162.7 ± 32.3 min 9 had a Glasgow outcome Score (GOS) of 5, 1 had GOS 4, 1 had death, resulting from sepsis. Mean follow-up is 2.81 months and no complications could be observed within this period.

Conclusion

Primary reconstruction of compound fractures should be attempted in any possible case, even in ones with delayed presentation. When done with native bone fragments and titanium mesh provides cosmesis, protection, prevention of skin flap syndrome and better strength of construct. Although the rate of infection has been nil in our series, a larger series with longer follow-up is warranted before introducing into clinical practice.

Keywords

Primary reconstruction - Compound fracture - Bone-mesh

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