Faculty Collaboration Database

Traumatic fracture of a polymethyl methacrylate patient-specific cranioplasty implant. World Neurosurg 2014;82(3-4):536.e11-3

Date

09/24/2013

Pubmed ID

24056094

DOI

10.1016/j.wneu.2013.09.025

Scopus ID

2-s2.0-84922309925 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

OBJECTIVE: To present a case of a traumatic fracture of a polymethyl methacrylate (PMMA) patient-specific implant (PSI) for cranioplasty.

METHODS: A 14-year-old boy with a history of right decompressive hemicraniectomy and reconstructive cranioplasty with a PMMA PSI presented after an unhelmeted bicycle accident with somnolence, confusion, seizures, left hemiparesis, and an obviously deformed cranium.

RESULTS: Computed tomography scan showed a comminuted, depressed fracture of the implant and cerebral contusions. The implant was seen to be shattered, resulting in displaced, overriding fragments and significant damage to underlying brain. The patient remained neurologically stable. To minimize the number of operations, intervention was delayed while a polyetheretherketone PSI was fabricated. During surgery, it was noted that the fractured pieces of the implant had caused dural lacerations, and some pieces were embedded in brain parenchyma. The fractured PMMA was removed, and the new implant was placed. The patient remained hemiparetic and was later transferred to an inpatient rehabilitation facility.

CONCLUSIONS: PMMA PSIs are commonly used for large defects and generally have good outcomes with low rates of revision. The case report described involves a shattered PMMA PSI after a traumatic impact, which resulted in hemiparesis. The question arises if this type of complication can be easily avoided with the addition of titanium onlay to restrict displacement in the event of fracture. This onlay represents a minor change of technique that could prevent migration of fracture fragments.

Author List

Ko AL, Nerva JD, Chang JJ, Chesnut RM

Author

John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Bicycling
Bone Cements
Decompressive Craniectomy
Humans
Male
Nervous System Diseases
Paresis
Polymethyl Methacrylate
Postoperative Complications
Prostheses and Implants
Skull Fractures