The objective of this study is to evaluate, through a systematic review of the scientific literature and meta-analysis, the applications of three-dimensional (3D) printing in the surgical treatment of complex fractures of the appendicular skeleton, mainly in terms of effectiveness and safety. A systematic review of the scientific literature was conducted in MEDLINE (PubMed) and the Cochrane Library combining different keywords. A specific methodological assessment scale was developed and applied to included papers. Ten studies were included; all of them were controlled trials, except for one retrospective observational cohort study. We observed statistically significant differences between the group that used 3D printing and the control group in terms of reduction in surgical time, reduction in the volume of blood lost during surgery and reduction in the number of intraoperative fluoroscopies, in favor of the 3D printing group. No statistically significant differences were observed in terms of fracture healing time, postoperative joint function, or postoperative complications. Meta-analysis revealed more favorable results for 3D-printing compared with conventional surgery, with the greatest difference observed for the number of intraoperative fluoroscopies. 3D printing might be considered effective and safe in the surgical treatment of anatomically complex appendicular skeleton fractures, in terms of reducing surgical time, lost blood volume, and radiation exposure of surgeons and patients.

Distal femur fractures are increasing injuries in our environment, due to their close relationship with the aging of the population. The diagnosis and treatment of these injuries have evolved in recent years, and the availability of new tools allows us to improve the results of our patients. Techniques such as dual nail-plate or plate-plate fixation emerge as an option in complications and complex fractures, and augmentation with PMMA may be an option in very low-density bones. To use these new techniques, anatomical knowledge, especially of the medial aspect of the femur, is essential. Many recent publications have studied the use of minimally invasive techniques with safe pathways. Throughout the following pages, we give a glimpse of the novelties in the treatment of these fractures, and we review the classic concepts.