Proof of Concept for Metacarpal Reconstruction Using a Custom 3-dimensional-Printed Titanium Implant: Design, Manufacturing, Surgical Technique, and Early Postoperative Outcomes.

This case report describes the use of a 3-dimensional-printed, custom titanium implant for the reconstruction of a complex post-traumatic metacarpal malunion. A 33-year-old woman with an open fracture of the right second metacarpal progressing to malunion from a motor vehicle accident underwent single-stage hand reconstruction using a custom implant. This report outlines preoperative planning, implant design, manufacturing, and surgical execution. Postoperative imaging confirmed appropriate implant positioning, soft tissue balancing, and deformity correction. The custom implant restored joint alignment and motion, resolving the preoperative fixed hyperextension contracture of the digit. At the 2-year follow-up, the implant demonstrated good incorporation without loosening and maintained digit function. This case demonstrates the unique application of a custom 3-dimensional-printed implant, from implant design through surgical execution, for complex hand reconstruction where alternative off-the-shelf options are not feasible, and highlights advantages in anatomical restoration and surgical precision in challenging patient populations.