Abstract
INTRODUCTION: Intra-articular calcaneal fractures are generally treated with open reduction and internal fixation in order to restore calcaneal anatomy as well as subtalar and calcaneocuboid joint congruency. Bone loss is common due to the impaction of cancellous bone beneath the posterior facet as a result of axial loading. Critical-sized bone defects are commonly addressed with the Masquelet "induced membrane technique" incorporating autogenous or allogenous bone graft. Synthetic bone scaffolds are readily available and customizable through three-dimensional (3D) printing. This case report describes the novel use of a custom 3D-printed polycaprolactone-tricalcium phosphate (PCL-TCP) scaffold (Osteopore®) in conjunction with the Masquelet technique in the management of a critical-sized bone defect for a patient with an open intra-articular calcaneal fracture. CASE REPORT: A gentleman sustained an open right calcaneal intra-articular fracture after a fall from height. The fracture was initially stabilized with a joint spanning external fixator while the patient underwent multiple surgeries for wound debridement and insertion of cement spacer. The skin defect was covered using a contralateral anterolateral thigh flap and the external fixator was converted to an Ilizarov circular frame 1 month after soft-tissue reconstruction surgery. Ten weeks after the initial injury, a custom scaffold was utilized to fill the bone defect encapsulated by a pseudomembrane formed by the cement spacer from earlier surgeries. Autogenous bone graft and BMAC was harvested from the ipsilateral iliac crest and packed into the scaffold. A cancellous screw was inserted, from the posterior calcaneal tuberosity through the subtalar joint into the talus, to anchor the scaffold. The Ilizarov frame was removed 3 months later. The bone defect was adequately addressed resulting in good restoration of calcaneal anatomy as well as joint congruency. At 3 years post-operation, the patient is ambulant without walking aids, reports minimal pain, and remains infection-free. Repeat radiographs show callus formation, bony fusion, and graft incorporation. CONCLUSION: This case report shows promising early results from the use of a custom PCL-TCP scaffold (Osteopore®) in conjunction with the Masquelet "induced membrane" technique in the management of a critical-sized bone defect for a patient with an open intra-articular calcaneal fracture.