🔍 Key Findings
- Precontoured plates based on 3D-printed femurs produced accurate femoral alignment (median deviations <3 mm or <3° in all planes).
- Both fracture reduction system (FRS) and intramedullary pin (IMP) methods achieved near-anatomic alignment in cadaveric femoral fractures.
- FRS required fewer fluoroscopic images (median 7 vs. 26, P = .001), but longer surgical time (median 43 vs. 29 min, P = .011).
- Sagittal plane alignment: FRS led to mild increased recurvatum (median 2.9°), but still within near-anatomic limits (<5°).
- Axial alignment: Both groups achieved near-anatomic torsion (<10°), though one IMP case had acceptable (not near-anatomic) alignment.
- Custom drill guides and FRS improved fluoroscopy efficiency but were cumbersome and time-consuming to use. Authors do not recommend current prototype for clinical use.
- Clinical significance: 3D printed models allow accurate precontouring, reducing intra-op plate adjustment; custom guides may reduce radiation exposure for the surgical team.

