Second metatarsal reconstruction after segmental bone loss using a custom 3D-printed implant: A case report

<h2>Abstract</h2> Reconstructing extensive bone loss in the foot after trauma poses a significant surgical challenge. The challenge becomes even greater when the injury involves weight-bearing structures. This case report presents the use of a custom 3D-printed implant to reconstruct the second metatarsal following loss of its distal portion. This injury was further complicated by dislocations of the third to fifth metatarsophalangeal joints with plantar protrusion of the third and fourth metatarsal heads through the foot. Additionally, a dislocation of the first tarsometatarsal joint was also present. A staged surgical approach was employed consisting of (1) irrigation and debridement of the open wound, reduction of the dislocated joints and placement of a temporary antibiotic spacer into the distal second metatarsal space (2) insertion of a fibular strut allograft into the distal second metatarsal space while the custom 3D implant was being designed and internal fixation of the first tarsometatarsal joint using a bridge plate and (3) definitive reconstruction of the second metatarsal using a patient-specific 3D-printed implant. Our surgical procedure restored foot anatomy and enabled our patient to return to full weight bearing. Postoperative radiographs confirmed excellent alignment, stability, and integration of the implant. This case highlights the transformative potential of 3D printing technology in addressing critical bone loss and restoring function in complex foot trauma. Custom implants offer significant advantages over traditional bone grafting techniques providing a promising solution for complex orthopedic reconstructions.