The Use of Platelet-Rich Fibrin Coated 3d Printed Scaffolds in Salvage of Complex Hindfoot Cases

Background: Complex hindfoot pathologies involving critical sized bone defects of talus are difficult to manage. The current management involves arthrodesis and bone grafting with the defective talus which have limitations in restoring structural integrity and functional goals. The advancement of 3D printed scaffolds have opened new avenues to address such complex hindfoot pathologies which may potentially improve treatment outcomes. The addition of Platelet-rich fibrin further enhances healing potential. Method: This is a retrospective study involving 6 patients with severe hindfoot bone loss where 3D printed scaffolds coated with PRF were performed as a salvage surgery from 2023 to 2024. We intend to to investigate the clinical outcomes in terms of healing time and union rate. Additionally we would evaluate the degree of deformity corrections and patient clinical outcomes. Results: This report includes 6 complex reconstructions where all the patients (100%) achieved CT confirmed union with mean duration of 20.2 weeks. All patients were able to ambulate in full weight bearing after an average duration of 23.3 weeks. There were significant improvement in all radiological parameters. Patients demonstrated improved VAS from 7.5 ± 1.4 points to 2.3 ± 1.2 and functional scores in all domains utilizing AOFAS score, FFI and SF-36. Conclusion: This demonstrated the potential of PRF coated 3D printed scaffold in managing complex hindfoot cases especially in the presence of significant bony defects. This modality demonstrated excellent union rate of 100%, near anatomical correction and good functional outcomes with low complication rate.