Carbon-fibre plates for traumatic and (impending) pathological fracture fixation: Where do we stand? A systematic review

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.

Microstrain Ability and Biocompatibility of 3D Needle-Punched Carbon Fiber/Poly(ether ether ketone) Composite Bone Plates

“…This property is crucial for bone plates because it allows for effective load bearing without excessive bulk so that it can realize the internal fixation of weight-bearing bone fractures. 22,23 CF/PEEK composites combine the excellent properties of PEEK and carbon fiber, with good biocompatibility, chemical resistance, excellent resistance to body fluids, lightweight and high strength, and ray transmissibility, making it a good orthopedic implant material. 24 There have been many reports on different fiber-reinforced resin matrix materials, 26−29 and carbon fiber has received much attention as a reinforcing fiber with high specific strength.…”

“…It provides robust mechanical properties while remaining lightweight. This property is crucial for bone plates because it allows for effective load bearing without excessive bulk so that it can realize the internal fixation of weight-bearing bone fractures. , CF/PEEK composites combine the excellent properties of PEEK and carbon fiber, with good biocompatibility, chemical resistance, excellent resistance to body fluids, lightweight and high strength, and ray transmissibility, making it a good orthopedic implant material. , …”

“…There have been many reports on different fiber-reinforced resin matrix materials, − and carbon fiber has received much attention as a reinforcing fiber with high specific strength. Continuous carbon fiber-reinforced PEEK composite laminated bone plates have entered the clinical application stage in some countries, but there are still some limiting factors for the application: (i) Continuous carbon fiber composites are an anisotropic material, with excellent mechanical properties within the in-plane but poorer interlaminar properties; (ii) continuous carbon fiber composite material is not easy to be processed into complex shapes; (iii) its modulus of elasticity is still much higher than that of human bone, and it cannot completely circumvent the stress shielding effect. ,, Therefore, although continuous carbon fiber-reinforced PEEK composites have been successfully used in clinical applications, there is still room for improvement to make them closer to the application of “patient-specific bone plates.”…”