Carbon-Fibre-Reinforced PEEK radiolucent intramedullary nail for humeral shaft fracture fixation: technical features and a pilot clinical study

Kojic, Niksa; Rangger, C.; Özgün, Celenk; Lojpur, Jakisa; Mueller, Jerome; Folman, Yoram; Behrbalk, Eyal; Bakota, Bore

doi:10.1016/s0020-1383(17)30731-3

Cited by 17 publications

(5 citation statements)

References 23 publications

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“…Promising biomaterials recently explored are the resorbable reinforced composites, 1 the magnesium alloys 78,91,92 and shape memory alloys. 93,94 In relation to reinforced composites, a commercially available example is the CarboFix, 95 a carbon fibre reinforced with polyaryl-ether-ether-ketone (PEEK) intramedullary nail where the carbon fibres are the load and tension carriers and the PEEK matrix maintains the fibres in the desired location and orientation. Another interesting reinforced composite material which is being tested is the poly(methyl methacrylate) intramedullary nail.…”

Section: Modern Trendsmentioning

confidence: 99%

Intramedullary nailing biomechanics: Evolution and challenges

Rosa

Marta

Vaz

et al. 2019

Proc Inst Mech Eng H

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This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuitionbased experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail 'dynamization' and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the boneintramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.

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Section: Modern Trendsmentioning

confidence: 99%

Intramedullary nailing biomechanics: Evolution and challenges

Rosa

Marta

Vaz

et al. 2019

Proc Inst Mech Eng H

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“…PEEK applications in orthopedics continue to grow, with just a couple being in fracture fixation [ 24 , 25 , 26 ] and commercialized dental implants such as VESTAKEEP PEEK. PEEK is one of several polymers that has been investigated for scaffold application in BTE, some of which include PCL [ 27 , 28 ], Polyurethane [ 29 ], and PLA [ 30 , 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Low-Temperature Plasmas Improving Chemical and Cellular Properties of Poly (Ether Ether Ketone) Biomaterial for Biomineralization

Bradford,

Hernandez-Moreno,

Pillai

et al. 2023

Materials

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Osteoblastic and chemical responses to Poly (ether ether ketone) (PEEK) material have been improved using a variety of low-temperature plasmas (LTPs). Surface chemical properties are modified, and can be used, using low-temperature plasma (LTP) treatments which change surface functional groups. These functional groups increase biomineralization, in simulated body fluid conditions, and cellular viability. PEEK scaffolds were treated, with a variety of LTPs, incubated in simulated body fluids, and then analyzed using multiple techniques. First, scanning electron microscopy (SEM) showed morphological changes in the biomineralization for all samples. Calcein staining, Fourier transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS) confirmed that all low-temperature plasma-treated groups showed higher levels of biomineralization than the control group. MTT cell viability assays showed LTP-treated groups had increased cell viability in comparison to non-LTP-treated controls. PEEK treated with triethyl phosphate plasma (TEP) showed higher levels of cellular viability at 82.91% ± 5.00 (n = 6) and mineralization. These were significantly different to both the methyl methacrylate (MMA) 77.38% ± 1.27, ethylene diamine (EDA) 64.75% ± 6.43 plasma-treated PEEK groups, and the control, non-plasma-treated group 58.80 ± 2.84. FTIR showed higher levels of carbonate and phosphate formation on the TEP-treated PEEK than the other samples; however, calcein staining fluorescence of MMA and TEP-treated PEEK had the highest levels of biomineralization measured by pixel intensity quantification of 101.17 ± 4.63 and 96.35 ± 3.58, respectively, while EDA and control PEEK samples were 89.53 ± 1.74 and 90.49 ± 2.33, respectively. Comparing different LTPs, we showed that modified surface chemistry has quantitatively measurable effects that are favorable to the cellular, biomineralization, and chemical properties of PEEK.

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“…The first question, of course, is: Are these advantages real? The short answers range from “yes” to “probably.” Multiple authors have reported improved fracture reduction visualization and healing monitoring with CF-PEEK intramedullary nails compared to metal implants [3, 12]. Likewise, researchers found that markedly less artifact was generated on scans performed for healing assessment, radiation treatment planning, or tumor monitoring [3, 4], and even less therapeutic radiation scatter and dose attenuation has been suggested in an in vitro study [4].…”

mentioning

confidence: 99%

“…The short answers range from “yes” to “probably.” Multiple authors have reported improved fracture reduction visualization and healing monitoring with CF-PEEK intramedullary nails compared to metal implants [3, 12]. Likewise, researchers found that markedly less artifact was generated on scans performed for healing assessment, radiation treatment planning, or tumor monitoring [3, 4], and even less therapeutic radiation scatter and dose attenuation has been suggested in an in vitro study [4]. A biomechanical study [11] noted a high cycle fatigue strength for a CF-PEEK intramedullary nail of 283 MPa, similar to stainless steel but less than titanium (860 MPa), and an ostensibly desirable modulus of elasticity of 42 GPa (Titanium = 110 GPa, cortical bone 11-20 GPa) [11].…”

mentioning

confidence: 99%

“…While internally fixed distal radius fractures are not exactly known for exposure to high loads or frequent plate breakage, this does highlight potential concerns for fixation of other (for example, lower extremity) fractures. One series of 46 humerus fractures reported two implants which required “repositioning” and a third requiring return to the operating suite for (intraarticular) prominence [3]; while this certainly can happen with easily visualized metal implants, it should not.…”

mentioning

confidence: 99%

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