Clinical and functional outcomes of upper extremity 3D-printed immobilization devices compared to traditional...

Fractures are a common cause of emergency department visits, and immobilization choice affects not only fracture healing but also comfort, hygiene, mobility, and quality of life. Conventional casting remains standard but is associated with limitations, including bulk, discomfort, and poor water tolerance. 3-Dimensional (3D)-printed, patient-specific immobilization may improve ventilation and functional tolerance while maintaining stability, but clinical evidence is still emerging and heterogeneous. This systematic review aims to evaluate the current clinical evidence on 3D-printed immobilization technologies versus traditional standard methods for fracture management in both pediatric and adult patients with respect to fracture healing, stability, pain, and functional recovery.

A comprehensive search of PubMed, Scopus, and Web of Science databases was performed from database inception until November 2025 on the topic of evaluating 3D-printed technology to create casts, splints, or orthoses for upper-extremity fracture immobilization. Due to heterogeneity in design, interventions, and outcome reporting, results were synthesized narratively.

Of 828 articles retrieved from the initial search, 581 studies were included for screening after removing duplicate articles, and underwent title and abstract screening, with 32 full-text studies assessed for eligibility. Thirteen studies met full inclusion criteria, while 19 studies were excluded. Twelve (n = 456) were included in the result analysis as they all focused on upper-extremity fractures, all of which had a moderate-to-high risk of bias. Fracture union was reported at or near 100% across studies. Patient satisfaction generally favored 3D-printed immobilization (10/11 studies), with a non-significant large, pooled effect (Hedges' g = 0.83; 95% CI = 0.21-1.88; p = 0.085; I² = 77.5%). Pain showed a non-significant small-to-moderate benefit (g = 0.36; 95% CI = 1.94-2.66), and functional outcomes were similar between groups (g = 0.13; 95% CI = 1.02-1.28). Skin-related outcomes more often favored 3D-printed devices (7/9 studies), with reduced irritation and hygiene burden, while device weight was consistently lower, but cost and production time were higher.

3D-printed immobilization devices show comparable fracture healing and improved patient satisfaction and skin tolerability compared with conventional casting, with early functional advantages that are not consistently sustained long term. However, the evidence is limited by small sample sizes, short follow-up, moderate-to-high risk of bias, and substantial heterogeneity, resulting in low-to-moderate certainty. Larger, high-quality randomized trials with longer follow-up are needed to confirm these findings and inform clinical recommendations.

Protocol registered prospectively in an international systematic review registry (PROSPERO) (registration number: CRD420251182244).