Three-Dimensional Printed Calcaneus Implant for Open Calcaneal Fracture with Extensive Bone Loss: A Case Report and Literature Review.

ABSTRACT

Open calcaneal fractures with extensive bone loss and severe soft tissues injuries are very rare. There is no treatment protocol for these severe injuries. The incidence of infection, osteomyelitis, and amputation is high compared to closed calcaneal fractures. An independent prognostic factor for increased complications is the high type of fracture according to Gustillo and Anderson's classification. A one-stage or two-stage procedure with open reduction and internal fixation, external fixation, percutaneous pinning, minimally invasive procedures, and subtalar arthrodesis are treatment options. We present a case of open type IIIB fracture of the calcaneus with extensive bone loss managed with a two-stage procedure. First, a cement spacer was inserted to fill the void and then, after the soft tissue envelope had healed with no sign of infection, a three-dimensional (3D) printed custom-made calcaneus implant was inserted. This is the first report in the literature of using a 3D custom-made calcaneal implant for a severe open calcaneal fracture with extensive osseous defect. At one-year follow-up, plain radiographs of the foot showed the calcaneus implant in place. The American Orthopedic Foot and Ankle score (AOFAS) was 76, and the patient had mild restrictions to his daily activities due to mild heel pain.