Search results

A total of 214 studies were identified through searches across three databases. Subsequently, 16 articles were excluded owing to duplication, and 24 articles were excluded owing to inappropriate language. Following a review of abstracts and titles, 132 articles were excluded on the basis of the predefined inclusion and exclusion criteria. Subsequent full-text assessment led to the exclusion of 4 studies owing to inappropriate interventions and 23 studies owing to inappropriate populations suffering other orthopedic disorders but not fractures. Also, we excluded an systematic review because it did not have available data. Ultimately, 14 studies met the inclusion criteria and were included in the analysis. Figure 1 depicts the literature screening procedure.

Fig. 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram to show study selection

Study characteristics

Table 2 lists the basic characteristics of the MAs included in this study. The MAs included in this review were released between 2018 and 2024. This study included the following common fractures: tibial plateau fracture, acetabular fracture, pelvic fracture, and other fractures. A total of 12 studies gave the average age of patients, and in all of these studies, the average age of patients was < 60 years old but > 18 years old (with no minors included). A total of 11 studies gave the sex ratio of included patients, of which only one study had a higher proportion of women than men [3]. A total of 14 studies gave the number of included patients, of which only 1 study had more than 1000 patients [10]. We conducted evidence evaluation on the extracted outcomes (Supplementary Material E). A total of 48 outcomes were rated as level IV, 1 outcome was rated as level III, and 45 outcomes were rated as NS. In addition, we evaluated these outcomes using GRADE, with a total of 48 outcomes rated as moderate, 5 outcomes rated as very low, 27 outcomes rated as low, and 14 outcomes rated as high. We extracted the main conclusions from all the studies included in this review (Supplementary Material F). Six meta-analyses had a high AMSTAR 2 rating [3, 5, 6, 9, 12, 16]. Six meta-analyses had a moderate AMSTAR 2 rating [1, 2, 7, 10, 13, 15]. The rest of the meta-analyses had a low AMSTAR 2 rating [8, 11] (Supplementary Material D).

Table 2 Basic information about study patientsResults of umbrella reviewAcetabular fracture

Three MAs [13, 15, 16] reported on acetabular fracture. Regarding how 3D printing helps patients who are suffering acetabular fracture and need surgery, there was overlap between the three MAs. The GROOVE tool was used to identify the overlap of these three MAs, and the specific results are shown in Supplementary Material E. On the basis of the strategies for solving overlapping problems mentioned in the “Methods,” the results of the A. K. X. Lee. et al. study are considered to represent the best available evidence. The findings of the study by A. K. X. Lee. et al. show that, compared with conventional surgical treatment, 3D printing can help shorten operation time (ROM = 0.74, 95% CI 0.66–0.83, I2 = 93%), lower loss of blood (ROM = 0.71, 95% CI 0.63–0.81, I2 = 71%), and reduce the occurrence of postoperative complications (OR = 0.42, 95% CI 0.22–0.78, I2 = 9%). Specific data can be found in Supplementary Material F.

Distal radius fracture

Only one study [12] reported on distal radius fracture. The results suggested that 3D-printing-assisted surgery was better than routine surgery in terms of operation time (WMD = −14.52; 95% CI: −21.79 to −7.24; p < 0.0001; I2 = 97%), frequency of intraoperative fluoroscopy (WMD = −2.14; 95% CI −3.43 to −0.85; p = 0.001; I2 = 95%), and blood loss (WMD = −13.59; 95% CI −18.07 to −9.10; p < 0.00001; I2 = 74%). However, there were no statistically significant distinctions between 3D printing-assisted rehabilitation and traditional rehabilitation in terms of postoperative visual analog scale (VAS) (WMD = −0.55; 95% CI −1.72 to 0.62; p = 0.36; I2 = 91%) and Gartland–Werley scores (WMD = 0.56; 95% CI −4.18 to 5.30; p = 0.36; I2 = 0%). Specific data can be found in Supplementary Material F.

Proximal humerus fractures

Proximal humerus fracture was reported in only one MA [3]. The study by K. Li et al. reported that 3D-printing-assisted surgery for proximal humerus fractures shortens operation time (WMD = −19.49; 95% CI −26.95 to −12.03; p < 0.05; I2 = 91%), reduces blood loss (WMD = −46.49; 95% CI −76.01 to −16.97; p < 0.05; I2 = 98%), and obtains higher Neer score that includes evaluation of pain, function, range of motion, and anatomical positioning (WMD = 9.57; 95% CI 8.11 to 11.04; p < 0.05; I2 = 64%), with less harm to patients and significant advantages compared with traditional fracture surgery. Specific data can be found in Supplementary Material F.

Tibial plateau fracture

Two studies [1, 10] reported tibial plateau fracture. The GROOVE tool was used to identify that there was no overlap between the two MAs, so it was supposed that the data resulting from both studies could be included in the review (Supplementary Material E). As shown in Table 3, both the studies by Y. He et al. and L. Xie et al. indicated that 3D-printing-assisted surgery shortens operation time and reduces blood loss compared with traditional fracture surgery for tibial plateau fracture. Additionally, the study by L. Xie et al. showed the effectiveness of 3D-printing-assisted surgery by comparing the follow-up functional outcomes using Rasmussen score and hospital for special surgery knee score (HSS) score. However, in the study by L. Xie et al., there was no significant difference between 3D-printing-assisted surgery group and non-3D-printing-assisted group in terms of complications and follow-up functional outcomes, although most studies showed higher satisfactory outcome rate with the help of 3D printing technology. Specific data can be found in Supplementary Material F.

Table 3 Presentation of outcome data for tibial plateau fracturePelvic fracture

Two studies [11, 16] reported on pelvic fracture. The GROOVE tool was used to identify that there was no overlap between the two MAs, so it was supposed that the data resulting from both studies could be included in the review (Supplementary Material E). As shown in Table 3, both the studies by A. K. X. Lee et al. and J. Wang et al. indicated that 3D-printing-assisted surgery reduces operation time, blood loss, and the occurrence of postoperative complications compared with traditional fracture surgery for pelvic fracture. Additionally, the study by J. Wang et al. showed the effectiveness of 3D-printing-assisted surgery by comparing the excellent and good rate of pelvic function and pelvic fractures reduction using Majeed score and Matta score, respectively. Both studies showed that surgery for pelvic fractures performed with the assistance of 3D printing technology resulted in better reduction of fracture, but different methods were used for comparison. Specific data can be found in Supplementary Material F (Table 4).

Table 4 Presentation of outcome data for pelvic fractureDisplaced intraarticular calcaneal fracture

Only one study [5] reported on displaced intraarticular calcaneal fracture. The results suggested that 3D-printing-assisted surgery was better than routine surgery in terms of operation time (standardized mean difference (SMD) = −1.86; 95% CI −2.23 to −1.40; p < 0.05; I2 = 83%), postoperative complications (OR = 0.49; 95% CI 0.31 to 0.79; p < 0.05; I2 = 0%), and blood loss (SMD = −1.26; 95% CI −1.82 to −0.69; p < 0.05; I2 = 89%). Specific data can be found in Supplementary Material F.

Foot and ankle fracture

Only one study [6] reported on foot and ankle fracture fixation. The results indicated that 3D-printing-assisted surgery was superior to routine surgery in terms of operation time (MD = −23.52; 95% CI −39.31 to −7.74; p = 0.003; I2 = 99%) and blood loss (MD = 30.59; 95% CI 46.31 to −14.87; p = 0.0001; I2 = 98%). Specific data can be obtained from Supplementary Material F.

Other fractures

Several other studies [2, 7,8,9] have described other types of fracture, such as appendicular skeleton fracture, pilon fracture, and traumatic fracture. All these studies indicated the positive effects of 3D printing, especially in terms of operation time, blood loss, and postoperative complications. Specific data can be obtained from Supplementary Material F.