# The Use of Platelet-Rich Fibrin-Coated Three-Dimensionally (3D) Printed Scaffolds in Salvage of Complex Hindfoot Cases

## TL;DR

This study shows that 3D-printed scaffolds coated with platelet-rich fibrin can effectively treat complex hindfoot bone defects, leading to improved healing and function.

## Contribution

The novel use of PRF-coated 3D-printed scaffolds for complex hindfoot salvage is demonstrated with clinical outcomes.

## Key findings

- CT-confirmed union was achieved in six patients after an average of 20.2 weeks.
- Patients resumed full weight-bearing walking after an average of 23.3 weeks.
- Significant improvements in VAS and functional scores were observed post-treatment.

## Abstract

Background: Complex hindfoot pathologies involving critical-sized bone defects of the 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 has 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 six patients with severe talar bone loss secondary to osteomyelitis or avascular necrosis, where 3D-printed scaffolds coated with PRF were implemented in salvage surgery performed from 2023 to 2024. We intended to investigate the clinical outcomes in terms of healing time and union rate. Additionally, we evaluated the degree of deformity corrections and the patients’ clinical outcomes. Results: This study reports six complex reconstructions which achieved CT-confirmed union after a mean duration of 20.2 weeks. All patients were able to ambulate with full weight bearing after an average duration of 23.3 weeks. The patients demonstrated improved radiological parameters, VAS scores from 7.5 ± 1.4 points to 2.3 ± 1.2, and functional scores in all domains for AOFAS, FFI and SF-36. Conclusion: This study demonstrates the benefits of PRF-coated 3D-printed scaffolds in managing complex hindfoot cases, especially in the presence of significant bony defects. This modality has the potential to achieve a good union rate, near-anatomical correction and good functional outcomes.