Three-Dimensional Printing-Assisted Masquelet Technique in the Treatment of Calcaneal Defects

Abstract

Objective: The aim of the present study was to summarize the clinical efficacy of three-dimensional (3D) printing technology combined with the Masquelet technique in the treatment of calcaneal defects.

Methods: From January 2018 to April 2019, 3D printing combined with induced masquelet technology was used to treat four patients with calcaneal defects, including two men and two women. The patients were aged 22-52 years old, with an average age of 36 years. There were two cases of traffic accident injuries, there was one case of a fall from height, and there was one case of crush injury. CT scans were used to reconstruct the bilateral calcaneus, mirror technology was used to construct the bone defect area, and Materialise 3-matic software was used to design the calcaneus shaper mold and 3D print the mold. During the operation, the mold was used to shape the bone cement and fill the bone defect. In the second stage, the bone cement was removed and autologous bone was implanted to repair the bone defect. All patients were followed up to observe the effect.

Results: All four patients were followed up for 14 months (range, 10-18 months). There were three cases of infectious bone defects: two cases of Escherichia coli and one case of Pseudomonas aeruginosa. The 3D printed mold was used to shape the bone cement. During the operation, it was found to have a high degree of matching with the defect area of calcaneus. There is no need to adjust it again, and the wound healed well after the first stage. In the second stage of surgery, it was found that the induced membrane formed was complete and of appropriate size; the bone cement was easily removed during the operation. The fracture healing time was 3-6 months, with an average of 4 months. At the last follow up, there was no pain and the patients walked with full weight bearing. The Maryland score was 94 points (range, 88-98 points); three cases were excellent and one case was good. The AOFAS score ranged from 86 to 98, with an average of 92.8 points; three cases were excellent and one case was good.

Conclusion: Three-dimensional printing technology combined with induced membrane technology is an effective approach for treating calcaneal bone defects.

Keywords: Bone diseases; Bone transplantation; Bones; Calcaneus; Fracture healing; Models; Printing; Reconstructive Surgical procedures; Three-dimensional.