Intramedullary nailing for impending or pathologic fracture of the long bone: titanium vs carbon fiber peek nailing

Abstract

Purpose The aim of this study is to compare titanium vs carbon fiber intramedullary (IM) nailing in terms of response to radiotherapy, local control of the disease, time of surgery, fluoroscopy exposure, and complications. Methods From 2015 to 2021, 52 impending or pathologic fractures were treated with IM nailing in 47 patients: 18 males and 29 females with a mean age of 73. Titanium nails were used in 27 cases: femur (17 cases), humerus (8 cases), and tibia (2 cases). Carbon fiber nails were used in 25 cases: femur (17 cases), humerus (7 cases), and tibia (1 case). Results At a mean follow-up of 8.4 months, most patients died from the disease (63.4%). Fracture healing without osteolysis progression was present in 52% of titanium nailing at a mean time of 6 months and in 53% of carbon fiber nails at a mean time of 4.6 months. No statistically significant difference has been shown in terms of healing (P = 0.5), intraoperative fluoroscopy (P = 0.7), and time of surgery in femoral nailing (P = 0.6), while a significantly lower surgical time for carbon fiber humeral nailing (P = 0.01) was found. Two breakages of carbon fiber femoral nails were observed, and both were treated with revision with modular tumor megaprosthesis. Conclusions Our results suggest that surgical time and fluoroscopy exposure are not longer for carbon fiber nails compared to titanium ones. Healing seems to be faster in carbon fiber nails. Further clinical studies are needed to clarify the long-term outcomes of these implants.

Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review

“…In contrast, according to Pala et al, the heightened elasticity of a carbon fiber polymer might permit substantial movement, probably with a higher risk of delayed union and nonunion: their study demonstrated a high incidence of implant failure and nonunion (31% non-union rate) when CFR nails were employed in corrective osteotomies for lower limb deformities [25].…”

“…Carbon fiber nails exhibit low artifact levels, allowing radiotherapists to administer a more effective dose with reduced risks for the patient [25]. This characteristic underscores the potential benefits of CFR implants in the management of oncological patients undergoing radiotherapy [14].…”

“…Therefore, while carbon fiber implants offer several advantages, careful consideration and planning are required to mitigate potential risks associated with their use. Traditional implants (titanium) seem to demonstrate higher failure rates, especially in pathologic fractures, often due to nonunion or hardware failure as shown in Ziran et al's analysis on the healing process of diaphyseal tibia fractures, where the use of CFR nails led to a more rapid healing process than the use of titanium nails [13,25].…”

Septic Tibial Shaft Non-Union Treated by One-Step Surgery Using a Custom-Made Intramedullary Antibiotic Cement-Coated Carbon Nail: Case Report, Focus on Surgical Technique and Brief Literature Review

“…It can make difficult the bone healing or other complications evaluation during the follow-up. In addition, carbon fiber constructs have an elastic modularity more like bone cortex than titanium: it can improve the resistance to mechanical stress and bring to a faster recovery [14,15].…”

Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review

“…CFR-PEEK nails seem to be a good solution in patients with pathologic or impending fractures of the long bones [24]. No matter of life expectancy, studies suggest that either intramedullary nailing or plate fixation with bone cement augmentation and radiotherapy for pathological fractures of the humerus shaft are safe ways to improve quality of life and arm function [25][26][27][28][29][30].…”