Reconstruction of the Talus and Calcaneus Using a Three-Dimensional (3D)-Printed Custom Implant Following a Shotgun Wound: A Case Report.

We present a case detailing the successful reconstruction of the hindfoot in a 15-year-old male patient who suffered a self-inflicted shotgun wound. The patient had multiple complex fractures in these bones, resulting in considerable bone loss and the destruction of the articular surface. Considering the extent of the injuries and the failure of prior intervention from an outside surgeon, traditional reconstruction methods would not have adequately addressed the severity of the damage. Consequently, the treating physician opted to address the deformity using a three-dimensional (3D)-printed custom implant to salvage the limb. The treatment involved a two-stage surgical plan. The first stage encompassed debridement with the removal of antibiotic cement, which had been placed at the time of the initial injury, followed by debridement and placement of a new temporary antibiotic spacer. A 21-day course of antibiotics was administered to combat the developing osteomyelitis. Following the successful eradication of the infection, a second surgery entailed removing the spacer and residual bone, inserting the 3D-printed implant filled with bone graft, and fusing the hindfoot. Post-surgery, the patient steadily progressed from non-weight-bearing to full weight-bearing and was fully weight-bearing at five months post-surgery. He had reported significant improvements in pain and mobility. There were no complications, and the 3D-printed implant exhibited excellent integration with the surrounding bone tissue with a two-year follow-up. This case serves as a demonstration of the utility of 3D-printed custom implants in severe foot and ankle trauma, showcasing the technology's potential to revolutionize orthopedic surgery. Despite the potential risks, this approach highlights significant benefits and opens avenues for tailored reconstructions in complex orthopedic injuries.