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Bhashyam AR, Yeung C, Sodhi A, Xu RF, Groot OQ, Kelly S, Lozano-Calderon S. Titanium vs. carbon fiber-reinforced intramedullary nailing for humeral bone tumors. J Shoulder Elbow Surg 2023; 32:2286-2295. [PMID: 37263478 DOI: 10.1016/j.jse.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multiple techniques have been described to treat humeral diaphyseal bone tumors requiring curettage or excision. Recent studies have suggested that carbon fiber-reinforced polyetheretherketone (CFR-PEEK) intramedullary nails (IMNs) may be preferable to titanium IMNs for patients with musculoskeletal tumors due to CFR-PEEK's high tensile strength, radiolucency, a modulus of elasticity closer to native bone, and improved postoperative surveillance/radiation dosing. In this study, we describe the rate of fixation failure for both CFR-PEEK and titanium humeral IMNs when used for humeral diaphyseal bone tumors requiring curettage or excision. METHODS This was a single-institution retrospective cohort study including 81 patients (27 CFR-PEEK and 54 titanium) treated for a humeral diaphyseal bone tumor using an IMN ± methylmethacrylate between January 2017 and December 2022. Primary outcome was revision surgery due to soft tissue complications, nonunions, structural complications such as periprosthetic fracture or IMN breakage, periprosthetic infection, tumor progression, and implant failure due to rejection or fatigue. RESULTS No failures were observed in either patients treated with titanium nails or patients treated with CFR-PEEK not requiring curettage. Fixation failure due to implant failure was observed in 2 cases-at 214 days and 469 days after surgery-where CFR-PEEK IMN was used for stabilization after a wide segmental resection for oncologic control with a cement spacer reconstruction. In both cases, the resection was larger than 6 cm, the remaining distal humerus was less than 5 cm, and failures occurred at the interface of the residual bone and spacer. Both patients were revised using a titanium distal posterolateral humeral plate fixed with screws and cables without any subsequent complications. One additional CFR-PEEK IMN required revision surgery after 744 days due to progression of the tumor and subsequent nonunion. One revision surgery was observed after 63 days for the titanium IMN because of nonunion and tumor progression. CONCLUSIONS Humeral diaphyseal bone tumors requiring large segmental resection with small residual bone and a large cement spacer may fail via tension due to bending forces at the distal portion. In this clinical scenario, the use of larger-diameter CFR-PEEK IMNs may be indicated when available. In the interim, use of intercalary allografts instead of cement spacers, additional fixation with a titanium plate distally, or the use of a titanium nail when using a cement spacer may be considered.
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Affiliation(s)
- Abhiram R Bhashyam
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Caleb Yeung
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Alisha Sodhi
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Raylin F Xu
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Olivier Q Groot
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Sean Kelly
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
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Rijs Z, Weekhout A, Daniel S, Schoones JW, Groot OQ, Lozano-Calderon SA, van de Sande MAJ. Carbon-fibre plates for traumatic and (impending) pathological fracture fixation: Where do we stand? A systematic review. J Orthop Traumatol 2023; 24:42. [PMID: 37566178 PMCID: PMC10421838 DOI: 10.1186/s10195-023-00724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Carbon-fibre (CF) plates are increasingly used for fracture fixation. This systematic review evaluated complications associated with CF plate fixation. It also compared outcomes of patients treated with CF plates versus metal plates, aiming to determine if CF plates offered comparable results. The study hypothesized that CF plates display similar complication rates and clinical outcomes as metal plates for fracture fixation. METHODS The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched from database inception until June 2023: PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Emcare, Academic Search Premier and Google Scholar. Studies reporting on clinical and radiological outcomes of patients treated with CF plates for traumatic fractures and (impending) pathological fractures were included. Study quality was assessed, and complications were documented as number and percentage per anatomic region. RESULTS A total of 27 studies of moderate to very low quality of evidence were included. Of these, 22 studies (800 patients, median follow-up 12 months) focused on traumatic fractures, and 5 studies (102 patients, median follow-up 12 months) on (impending) pathological fractures. A total of 11 studies (497 patients, median follow-up 16 months) compared CF plates with metal plates. Regarding traumatic fractures, the following complications were mostly reported: soft tissue complications (52 out of 391; 13%) for the humerus, structural complications (6 out of 291; 2%) for the distal radius, nonunion and structural complication (1 out of 34; 3%) for the femur, and infection (4 out of 104; 4%) for the ankle. For (impending) pathological fractures, the most frequently reported complications were infections (2 out of 14; 14%) for the humerus and structural complication (6 out of 86; 7%) for the femur/tibia. Comparative studies reported mixed results, although the majority (7 out of 11; 64%) reported no significant differences in clinical or radiological outcomes between patients treated with CF or metal plates. CONCLUSION This systematic review did not reveal a concerning number of complications related to CF plate fixation. Comparative studies showed no significant differences between CF plates and metal plates for traumatic fracture fixation. Therefore, CF plates appear to be a viable alternative to metal plates. However, high-quality randomized controlled trials (RCTs) with long-term follow-up are strongly recommended to provide additional evidence supporting the use of CF plates. LEVEL OF EVIDENCE III, systematic review.
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Affiliation(s)
- Zeger Rijs
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Amber Weekhout
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Stef Daniel
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivier Q Groot
- Department of Orthopaedics, Massachusetts General Hospital-Harvard Medical School, Boston, USA
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Giannoudis VP, Rodham P, Antypas A, Mofori N, Chloros G, Giannoudis PV. Patient perspective on the use of carbon fibre plates for extremity fracture fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03473-6. [PMID: 36656438 PMCID: PMC10368544 DOI: 10.1007/s00590-023-03473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Carbon fibre-reinforced polyetheretherketone (CFR-PEEK) plates represent an exciting development within trauma and orthopaedic surgery, offering advantages including radiolucency, material properties similar to bone, and lack of localised tissue reaction. As more call for trials examining their use, there is no data available as to the acceptability of these implants to patients. This study aimed to therefore examine the acceptability of CFR-PEEK plates to patients undergoing fracture surgery. METHODS This was a prospective cross-sectional survey of patients undergoing surgery for a fracture of the ankle, distal femur, distal radius, or proximal humerus. Once a decision had been made to pursue operative fixation with a plate, patients were provided with descriptions of both CFR-PEEK and stainless steel and titanium metal implants alongside the current clinical evidence. All patients undertook a questionnaire examining their views as to the advantages and disadvantages of CFR-PEEK plates, and whether they would be happy to participate in a trial comparing both. RESULTS Ninety-nine patients were happy to participate (64 females, mean age 50). Eighty-seven patients reported that they would want a CFR-PEEK implant for their fracture, and 76 reported that they would be willing to participate in an RCT comparing their use. Commonly reported advantages included radiolucency, low weight and biocompatibility. Disadvantages reported included cost and concerns regarding durability. CONCLUSIONS This study demonstrates that CFR-PEEK implants would be acceptable to patients undergoing fracture surgery, with high numbers of patients stating that they would be willing to participate in a randomised study examining their use.
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Affiliation(s)
- Vasileios P Giannoudis
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, Leeds General Infirmary, University of Leeds, Clarendon Wing, Level A, Clarendon Way, Leeds, LS1 3EX, UK
| | - Paul Rodham
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, Leeds General Infirmary, University of Leeds, Clarendon Wing, Level A, Clarendon Way, Leeds, LS1 3EX, UK
| | - Antony Antypas
- Leeds General Infirmary, Health Education Yorkshire and Humber, Leeds, UK
| | | | | | - Peter V Giannoudis
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, Leeds General Infirmary, University of Leeds, Clarendon Wing, Level A, Clarendon Way, Leeds, LS1 3EX, UK.
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Complications of patients with bone tumors treated with carbon-fiber plates: an international multicenter study. Sci Rep 2022; 12:18969. [PMID: 36348055 PMCID: PMC9643370 DOI: 10.1038/s41598-022-23519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
Carbon-fiber (CF) plates are a promising alternative to metal plates. However, reported experience in orthopaedic oncology remains limited. The aim of this study was to identify complications of patients with bone tumors treated with CF plates. Between February 2015 and May 2021, 13 centers retrospectively registered patients with bone tumors that were reconstructed using CF plates. Complications were identified, and timing and etiology of complications were noted. Similar complications were tabulated and classified based on mechanical, non-mechanical and paediatric complications. Mechanical complications included: (1) aseptic loosening or graft-host non-union, and (2) structural complications. Non-mechanical complications included: (3) soft tissue complications, (4) infection and (5) tumor progression. Specific paediatric complications included (6) growth arrest resulting in longitudinal or angular deformity. Ninety-six patients were included with a median follow-up time of 35 months. In total, 22 (23%) patients had complications. Mechanical complications included: 1 (1%) aseptic loosening, 2 (2%) non-unions, and 7 (7%) structural complications. Non-mechanical complications included 1 (1%) soft tissue complication, 4 (4%) infections and 5 (5%) tumor progressions. Paediatric complications occurred in 2 (2%) patients. This study suggests CF plates are safe to use in demanding reconstructions after bone tumor resections, presenting a seemingly low complication profile.
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The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures. J Orthop Trauma 2022; 36:e260-e264. [PMID: 35727005 DOI: 10.1097/bot.0000000000002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures. DESIGN Retrospective comparison. PATIENTS/PARTICIPANTS Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion. MAIN OUTCOME MEASUREMENTS The primary outcome was postoperative complications. Other outcomes included implant type, pathology, indication, and adjuvant therapy. RESULTS Fifty-three percent of cases used a CFI, whereas 47% of cases used a TI. There were no differences between groups with regard to anatomic location (P = 0.218), indication for surgery (P = 0.066), histology (P = 0.306), or postoperative adjuvant therapy (P = 0.308). Nineteen percent of cases incurred a postoperative complication in each group (P = 0.530), and no differences were noted with regard to complication type including implant failure (P = 0.442) and wound complications (P = 0.322). There was a cost saving of $400 with TI implants compared with CFI. CONCLUSIONS This is a high-risk population for postoperative complications after stabilization of pathologic fractures. Although there were no statistical differences in complications between CFI and TI, implant choice depends on patient characteristics and surgeon preference. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Goudriaan WA, Tordoir RL, Broekhuis D, van der Wal RJP. Early Failure of a Carbon-Fiber-Reinforced Polyetheretherketone Distal Femur Plate: A Case Report. JBJS Case Connect 2020; 10:e20.00041. [PMID: 32910577 DOI: 10.2106/jbjs.cc.20.00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE In this case, we report on a carbon-fiber-reinforced polyetheretherketone plate failure 4 months after implantation, radiation therapy, chemotherapy, and protective weight-bearing in a 75-year-old woman who sustained a nontraumatic pathological distal femur fracture due to lymphoma. CONCLUSION Although carbon-fiber composite implants are regularly used and, to date, there have been no reports of early clinical failures, the longevity of the implant's structural integrity after high-dose radiation and/or chemotherapy treatment has not been fully explored. Therefore, we deem it too early to conclude that carbon-fiber-reinforced polyetheretherketone implants are superior to conventional implants in treating (pathological) fractures.
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Affiliation(s)
- W Alexander Goudriaan
- Department of Orthopaedic Surgery, Leiden University Medical Center- Leiden, the Netherlands
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Samiezadeh S, Schemitsch EH, Zdero R, Bougherara H. Biomechanical Response under Stress-Controlled Tension-Tension Fatigue of a Novel Carbon Fiber/Epoxy Intramedullary Nail for Femur Fractures. Med Eng Phys 2020; 80:26-32. [PMID: 32430231 DOI: 10.1016/j.medengphy.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
Metallic intramedullary nails are the "gold standard" implant for repairing femur shaft fractures. However, their rigidity may eliminate axial micromotion at the fracture (causing delayed healing) and they may carry too much load relative to the femur (causing "stress shielding"). Consequently, some researchers have proposed fiber-reinforced composite nails, but only one evaluated cyclic fatigue performance. Therefore, this study assessed the cyclic fatigue response of a carbon fiber/epoxy nail with a novel ply stacking sequence of [02/-45/452/-45/0/-45/452/-452/452/-45/902] previously developed by the present authors. Nails were cyclically loaded in tension-tension at 5 Hz with a stress ratio of R=0.1 from 30% - 85% of the material's ultimate tensile strength (UTS). Thermographic stress analysis, rather than conventional fatigue testing, was used to obtain high cycle fatigue strength (HCFS), below which the nail can be cyclically loaded indefinitely without damage. Also, the mechanical test machine's built-in load cell and an extensometer were used to create stress-strain curves, from which the change in static EO and dynamic E* moduli were obtained. Results showed that HCFS was 70.3% of UTS (or about 283 MPa), while EO and E* remained at 42 GPa without any dRegradation during testing. The current nail shows potential for clinical use.
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Affiliation(s)
- Saeid Samiezadeh
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada, M5B2K3.
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON, Canada N6A4V2.
| | - Radovan Zdero
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada, M5B2K3; Division of Orthopaedic Surgery, Western University, London, ON, Canada N6A4V2; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada, N6A5B9.
| | - Habiba Bougherara
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada, M5B2K3.
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Carbon/PEEK nails: a case-control study of 22 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:643-651. [PMID: 31865455 DOI: 10.1007/s00590-019-02602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Interest around carbon/PEEK plates and nails has been raising. The elastic modulus close to the bone, the high load-carrying capacity and radiolucency make CFR/PEEK materials a potential breakthrough. In the literature, there are abundant data about CFR/PEEK plates in the treatment of proximal humerus, distal radius and distal fibula fractures. In patients affected by bone metastasis, CFR/PEEK nails were proved effective and safe with 12 months of follow-up. Very little is known about performances of CFR/PEEK nails in patients affected by other pathologies. PURPOSES The aim of the study was to evaluate safety and efficacy of CFR/PEEK nails in the treatment of various pathological conditions. It was also investigated whatever radiolucency of this nails could lead to a more objective evaluation of bone callus or disease site. PATIENTS AND METHODS In the study group were included 20 patients (22 bone segments) who underwent CFR/PEEK nail implantation (eight humerus, one tibia, nine femur and four knee arthrodesis). They were affected by pathological fractures, and in four cases, they required an arthrodesis of the knee. They were retrospectively evaluated considering nail failures and bone callus or disease progression (RUSH scores). Mean follow-up time was 11 months (min 6.8-max 20.3). In the control group were included patients treated with titanium nails in the same institution for the same pathologies. An interclass correlation coefficient (ICC) analysis was performed in both groups considering RUSH scores by two expert surgeon from two institution to assess whether radiolucency could lead to a more objective evaluation of disease or bone callus site. RESULTS The ICC of mean values between RUSH scores was 0.882 (IC 95%: 0.702-0.953) in the CFR/PEEK group, while it was 0.778 (IC 95%: 0.41-0.91) in the titanium group. Observers' evaluation showed a significantly higher obscuration by titanium nails than by CFR/PEEK nails. No osteosynthesis failures were reported in both groups. CONCLUSIONS Our results confirm the safety of CFR/PEEK nails in the short-medium term. The radiolucency of these materials led our observers to perform more objective evaluations of bone callus formation or disease progression compared to the titanium group given the higher ICC. LEVEL OF EVIDENCE III Case-control therapeutic study.
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Randall RM, Nagle T, Steckler A, Billow D, Berkowitz MJ. Dual Nonlocked Plating as an Alternative to Locked Plating for Comminuted Distal Fibula Fractures: A Biomechanical Comparison Study. J Foot Ankle Surg 2019; 58:916-919. [PMID: 31345755 DOI: 10.1053/j.jfas.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Indexed: 02/06/2023]
Abstract
The purpose of this cadaveric study was to compare the biomechanical properties of dual nonlocked plating and single-locked plating using matched pairs of isolated fibula specimens. Fractures were simulated in 10 matched pairs of isolated cadaveric fibulae and plated with a single lateral locking plate for right-sided specimens, or with a one-third tubular plate and a 7-hole 2.4-mm minifragment adaption plate for left-sided specimens. An external rotation torque was applied at a rate of 1°/second, and torque at 10° was measured. Each fibula specimen was evaluated using a micro computed tomography scanner, and bone mineral density was calculated as milligrams of bone per cubic centimeter of volume. Dual nonlocked plating and locked plating specimens demonstrated torque measurements that were not significantly different at 10° of external rotation (1.48 N·m and 1.92 N·m, respectively; p = .093). The stiffness of the dual nonlocked plated and locked plating constructs were not significantly different (p = .228 and p = .543, respectively). The effect of bone mineral density on maximum torque at failure was not a reliable predictor of maximum torque in either the dual nonlocked plating or locked plating specimens (R2 = 0.548 and R2 = 0.096, respectively). We found no differences in torque at 10° of external rotation or stiffness between locking plate and dual nonlocking plate fixation constructs. This study provides evidence that dual nonlocked plating likely constitutes adequate fixation in situations in which a locking plate is being considered for comminuted distal fibula fractures.
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Affiliation(s)
- Rachel M Randall
- Orthopaedic Surgery Resident, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH.
| | - Tara Nagle
- Principle Biomechanical Research Engineer, Biomechanical Engineering Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Andrew Steckler
- Director of Orthopaedic Skills Laboratory, Biomechanical Engineering Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Damien Billow
- Center Director for Trauma, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH
| | - Mark J Berkowitz
- Center Director for Foot and Ankle Surgery, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH
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Fragomen AT, McCoy TH, Fragomen FR. A Preliminary Comparison Suggests Poor Performance of Carbon Fiber Reinforced Versus Titanium Plates in Distal Femoral Osteotomy. HSS J 2018; 14:258-265. [PMID: 30258330 PMCID: PMC6148591 DOI: 10.1007/s11420-017-9587-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carbon fiber-reinforced (CFR) polymer implants have theoretical advantages over titanium plates. QUESTIONS/PURPOSES The aim of the present study was to assess our early outcomes with CFR plates in lateral opening-wedge distal femoral osteotomy to correct valgus lower limb malalignment. We asked the following: (1) Did the CFR polymer implant change time to union when compared with the titanium implant? (2) Did the incidence of displacement of medial cortical fractures differ between the implants? (3) Did the incidence of complications differ between the two techniques, and did other factors, such as bone graft material used, affect healing? METHODS A retrospective review of 16 limbs treated with an opening-wedge distal femoral osteotomy for genu valgum using either titanium (n = 10) or CFR plates (n = 6) was performed. Patient and clinical covariates as well as the primary outcome of time to union and secondary outcome of fracture displacement were collected and analyzed. RESULTS Those treated with CFR plates had longer times to union than did those in the titanium-treated group (median, 121.5 vs 81.5 days, respectively). The incidence of fracture displacement was higher in the CFR plate-treated group (CFR, n = 5/6; titanium, n = 1/10). Although the CFR plate-treated group had a 33% nonunion incidence while the titanium group had no nonunions, the study lacked the power to show significance. Bone graft material used did not affect outcome. Complication rates were higher in the CFR plate-treated patients. CONCLUSION The CFR plate was associated with a longer time to unite and higher fracture displacement rate than the titanium plate. As this is a retrospective case series, further research is required to confirm these results and clarify best practices in plating of distal femoral osteotomy for deformity correction.
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Affiliation(s)
- Austin T. Fragomen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, Cornell University, New York, NY 10065 USA
| | - Thomas H. McCoy
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge St, Boston, MA 20114 USA
- Division of Clinical Research, Massachusetts General Hospital, 185 Cambridge St, Boston, MA 20114 USA
| | - Fiona R. Fragomen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Mugnai R, Tarallo L, Capra F, Catani F. Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures. Orthop Traumatol Surg Res 2018; 104:877-882. [PMID: 29807189 DOI: 10.1016/j.otsr.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. HYPOTHESIS Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. MATERIALS AND METHODS Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. RESULTS The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (-16%) for the titanium plate. Statistical analysis between groups reported significant values (p<001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p=.197). DISCUSSION The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Raffaele Mugnai
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy.
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
| | | | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
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Pinter ZW, Smith KS, Hudson PW, Jones CW, Hadden R, Elattar O, Shah A. A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures. Foot Ankle Spec 2018; 11:223-229. [PMID: 28677405 DOI: 10.1177/1938640017718343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. LEVELS OF EVIDENCE Level IV: Retrospective Case series.
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Affiliation(s)
| | | | - Parke W Hudson
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Caleb W Jones
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan Hadden
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Osama Elattar
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- University of Alabama at Birmingham, Birmingham, Alabama
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