Orthopaedic surgeons across subspecialties have found increasing indications for three-dimensional (3D) printing technology because it has become more available. Three-dimensional printed objects have been used for education, preoperative planning, and the management of complex orthopaedic conditions. Orthopaedic oncologists and reconstruction surgeons have increased their utilization of custom 3D implants in the management of bone defects secondary to osseous resections or bone loss. Computed tomography scans and image reconstructions provide the necessary information for creation of precise prints of intact bone, bone defects, or orthopaedic implants.

Orthopaedic traumatologists are similarly faced with complex reconstructions because of bone loss after open fractures, infection, and previous surgical interventions. For many surgeons, biologic reconstruction has been the preferred means of addressing these lesions. Traumatologists have developed and advanced procedures centered on distraction osteogenesis and utilization of induced membranes to solve large areas of bone loss. Vascularized bone segment transfer has been used for certain defects when microvascular surgical support is available.

Unfortunately, biologic reconstruction of critical sized bone defects requires not only adequate local biology and advanced surgical techniques but is also effort and time intensive for the patient. For example, if distraction osteogenesis is being performed, patient compliance with the prescribed transport rate and rhythm is essential for procedural success. Regardless the attempt at biologic reconstruction, consolidation of the bone graft or regenerate bone can take months to occur and prolong weight bearing restrictions. Finally, outside of allograft transplantation, none of the above noted methods can be used to recreate or substitute for an articular surface.

The creation and use of custom 3D metallic implants for traumatic bone defects in orthopaedic trauma is a rapidly emerging area of exploration and study. Some benefits include immediate structural stability across the defect, potentially decreased reliance on patient compliance, and the ability, if necessary, to reconstruct articular bone loss. The narrative surrounding utilization of 3D printed technology in orthopaedic trauma has changed as the time and cost needed to acquire a custom metallic implant continues to decrease and its usage in other subspecialties increases.

This supplement explores the traditional techniques for management of critical bone defects in orthopaedic trauma and introduces the indications surgeons have found for custom 3D printing in their practices. Here, you will find unique scenarios involving malunions, nonunions, and bone loss in both the upper and lower extremity where 3D printed guides and implants have been used to solve complex clinical pathology. We hope to provide further information and knowledge to orthopaedic trauma surgeons who now have another therapeutic option for critical bone loss.

John A. Scolaro, MD

University of California, Irvine

Orange, CA