Impact of 3D technology on perioperative outcomes of articular and periarticular fractures: A systematic review and meta-analysis of RCT studies

Background: In recent years, three-dimensional (3D) printing and virtual preoperative planning have gained increasing importance in orthopaedic surgery. These innovative technologies for the management of articular and periarticular fractures enable a precise understanding of patient-specific anatomy and accurate preoperative simulations. Objectives: The objective of this systematic review and meta-analysis is to evaluate and summarize the impact of 3D-assisted techniques on perioperative outcomes in the surgical management of articular and periarticular fractures across different anatomical districts. Study design & methods: This review and meta-analysis was conducted in accordance with the PRISMA guidelines, and PICOS criteria. Randomized controlled trials (RCTs) investigating the use of 3D technology in the treatment of articular and periarticular fractures were systematically collected and analyzed. Inclusion criteria comprised level I RCTs comparing 3D-assisted surgery (including 3D printing and/or virtual surgical planning) with conventional surgical techniques. Studies were excluded if they were non-randomized or lacked sufficient outcome measures. The primary outcome evaluated was operative time; secondary outcomes included intraoperative blood loss, fluoroscopy duration, and postoperative complication rate. Results: 16 RCTs published between 2015 and 2024 were included, encompassing 881 patients (431 treated with 3D-assisted methods and 450 undergoing conventional surgery). The studies covered several anatomical regions, including tibial plateau, ankle, calcaneus, elbow, and wrist.Meta-analysis demonstrated that 3D-assisted surgery significantly reduced operative time (tibial plateau: MD = −12.8 min, p < 0.001; ankle: MD = −18.9 min, p < 0.001; elbow: MD = −16.3 min, p < 0.001; wrist: MD = −8.1 min, p < 0.001). Similarly, lower intraoperative blood loss were observed (tibial plateau: MD = −30.4 mL, p < 0.001; ankle: MD = −37.2 mL, p < 0.001; wrist: MD = −15.4 mL, p < 0.001) and fluoroscopy exposure (tibial plateau: MD = −2.1 min, p < 0.001; wrist: MD = −1.1 min, p < 0.001). No statistically significant differences were observed in postoperative complication rates among the analyzed anatomical districts. Conclusions: The findings of this meta-analysis suggest that the implementation of 3D technology in orthopaedic trauma surgery provides measurable perioperative benefits, including significant reductions in operative time, intraoperative blood loss, and fluoroscopy exposure, without increasing the risk of complications.