TRUMATCH™ Graft Cage – Long Bone

Hans-Christoph Pape, Ingo Marzi, Peter Giannoudis, David Hak, Christof Müller, Gerhard Schmidmaier, Martijn Poeze, Brett Crist, Brent Norris

Treatment of large segmental bone defects can be challenging. It is associated with a high risk of complications, such as nonunions and infections. The most common treatment methods are distraction osteogenesis, autologous bone grafting, and the induced membrane technique (Masquelet technique). The latter can address limitations of distraction osteogenesis regarding the maximum defect length and defect shape amenable to treatment. However, a shortcoming of the Masquelet technique is the lack of mechanical stability of the graft in larger defects.

The TRUMATCH™ Graft Cage–Long Bone (Fig 1) was specifically designed to provide internal structural support to the graft material while providing large pathways for nutrient flow and revascularization from the surrounding tissues. The cage is a 3D printed, patient specific, resorbable implant made of 96% polycaprolactone and 4% hydroxyapatite with degradation over 2–4 years. It is coated with calcium phosphate to promote mineralization and conversion to bone. The device is available in lengths ranging from 2.5 to 30 cm (in the United States up to 10 cm). It must be used in conjunction with traditional, rigid fixation.

The outer mesh of the graft cage can be produced to approximate the cortical surface of the missing bone. The inner mesh is made to approximate either the intramedullary canal or an intramedullary nail. The tubular graft construct reduces the amount of graft needed compared with filling the entire defect. The two halves of the mesh are hinged so that they can be opened to facilitate graft packing and to allow insertion over an intramedullary nail. There are large windows in the mesh which expose the packed bone graft to the surrounding soft tissues for vascular ingrowth.

The graft cage is indicated for use in skeletally mature adults and adolescents (12−21 years) for treatment of bone voids or surgical resections in nonarticular regions of the femur, tibia, and humerus.

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