BACKGROUND Three-dimensional (3D) imaging, computer-aided design, and additive manufacturing have enabled patient-specific implants for individualized cranial reconstruction. However, evidence remains heterogeneous regarding materials, indications, study designs, and comparators. This study aimed to systematically evaluate clinical outcomes, complications, anatomical and cosmetic results, operative characteristics, and economic considerations associated with 3D-manufactured patient-specific cranioplasty implants. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42023486538). MEDLINE (PubMed), Scopus, and Web of Science were searched from inception to May 31, 2026. Eligible studies evaluated 3D-prototyped or 3D-manufactured patient-specific implants for cranial defect reconstruction. Two reviewers independently performed study selection and data extraction. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Due to substantial heterogeneity, findings were synthesized narratively. RESULTS Of 128 records identified, 48 articles underwent full-text assessment and 36 studies were included. Evidence comprised retrospective comparative studies, case series, technical reports, and clinical reports involving titanium, polyetheretherketone, polymethylmethacrylate, calcium-phosphate-based materials, and other constructs. Patient-specific implants generally demonstrated favorable anatomical conformity and cosmetic outcomes, with some studies reporting reduced intraoperative modification and operative time. However, complication outcomes were inconsistent and influenced by patient, surgical, material, and follow-up characteristics. Economic findings were heterogeneous. CONCLUSION 3D patient-specific implants are a feasible option for complex cranial reconstruction and precise contour restoration. However, current evidence does not establish universal superiority over autologous bone or other alloplastic materials. Larger prospective comparative studies with standardized clinical and economic outcomes are warranted.
BACKGROUND Hip pointers are typically perceived as minor trauma with little cause for concern. Despite the possibility of long-term sequelae, limited research has been conducted on this topic. METHODS In this prospective cohort study, 89 high schools (4A to 6A) and 41 universities across all Football Bowl Subdivision (FBS) conferences were evaluated for game-related hip pointers over 12 (2010-2021) and 16 (2006-2021) seasons, respectively. Recruitment criteria were based on institutional size, level of sport skill, and the presence of a full-time athletic training staff. Outcomes of interest included total injuries, injury severity, injury category, primary type of trauma, injury situation, imaging and surgical procedures, player position, environmental factors, and playing surface. Injury incidence rates (IIRs) were calculated as injuries per 10 games = (number of injuries ÷ number of games) × 10. RESULTS Of 6031 games, 170 hip pointers were documented, with 63 (37.1%) reported during high school and 107 (62.9%) during collegiate play. Multivariate analyses of variance indicated a significant competitive level effect by total injuries (F4,165 = 3.459; P = 0.01), primary type of trauma (F10,159 = 2.967; P = 0.003), and injury situation (F9,160 = 1.993; P = 0.04). Post hoc analyses indicated a significantly lower (P < 0.05) incidence of hip pointers (0.2, 95% CI 0.1-0.2 vs 0.5, 0.4-0.6) primarily during rushing plays (0.1, 95% CI, 0.1-0.1 vs 0.2, 0.1-0.2) among high school vs college athletes, respectively. CONCLUSION A significantly greater incidence of hip pointers occurred during collegiate play when compared to high school competition. Addressing better ways to protect the hip, however, is recommended at both competitive levels.
