Spontaneous fracture of a titanium mesh cranioplasty implant in a child: A case report

Figure 1 Computerized tomography images before and after first cranioplasty. A: Axial computerized tomography (CT) image displayed the left temporo-parieto-occipital skull with local encephalocele; B: Three-dimensional (3-D) CT reconstruction revealing a 10 cm × 8 cm defect of the left temporo-parieto-occipital skull; C: 3-D CT reconstruction after first cranioplasty displaying an intact and ideally positioned prosthesis.

Figure 2 Images before, during, and after second cranioplasty. A: Three-dimensional (3-D) computerized tomography (CT) reconstruction before the second cranioplasty displayed a reverse “L”-shaped fracture of the titanium mesh prosthesis; B and C: CT at the coronal and sagittal plane revealed the prosthetic fissure (red arrow); D: Intraoperative photograph showing the clear edge of the titanium mesh fracture; E: The fractured titanium mesh was removed during the second cranioplasty; F: 3-D CT reconstruction after the second cranioplasty disclosed an intact and ideally positioned implant.

Figure 3 Three-dimensional model of skull-implant. A: Three-dimensional (3-D) printed skull model rotated on a horizontal plate simulated head rotation on a pillow; B and C: Force analysis model of head rotation on a pillow.

Figure 4 Finite element analysis model. A: Model of skull-implanted mesh; B: Stress life fatigue curve of the skull-implant model; C: Stress distribution analysis of the skull-implant model in contact with a pillow; D: Fatigue behavior analysis of the titanium mesh.