The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures

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.

Radiolucent implants in orthopedic oncology

“…In the largest study of patients treated with CFRP nails to date, Piccioli et al found only 1 case of postoperative screw loosening in their cohort of 53 patients, with no evidence of hardware breakage 21 . Herzog et al, meanwhile, compared 53 cases of carbon fiber implants with 47 cases utilizing standard titanium 22 . In this study, they found 13% of patients had a complication related to implant failure, with 8 (15%) in the carbon fiber group and 5 (10%) in the titanium group.…”

“…In the study by Herzog et al of 100 CFRP or titanium nails, 59 patients follow-up for more than 6 months, but 41 followed-up for less than 6 months. 22 Of these 41, 32 had died before 6-month follow-up and 9 were alive and doing well but unable to make appointments. Piccioli found a 15% rate of progression in their cohort with pathologic fractures, with 1 patient developing a stress fracture proximal to the distal static locking screw of their humeral nail, 1 month after surgery.…”

“…Operative duration and intraoperative blood loss is less commonly reported on in studies using radiolucent nails in long bones. Herzog et al found that operative duration was decreased when using CFI (75.7 ± 43.7 min for CFI vs. 80.1 ± 27.1 min for TI) 22 . Meanwhile, Piccioli found a mean duration of procedure of 69 min (range 40−130 min) with intraoperative hemoglobin loss ranging from 0.3 to 3.5 g/dL and averaging 1.75 g/dL 21 …”

“…In this vulnerable patient population with metastatic disease requiring surgical stabilization, there is a significant rate of disease recurrence, progression, and mortality. In the study by Herzog et al of 100 CFRP or titanium nails, 59 patients follow‐up for more than 6 months, but 41 followed‐up for less than 6 months 22 . Of these 41, 32 had died before 6‐month follow‐up and 9 were alive and doing well but unable to make appointments.…”

“…Herzog et al found that operative duration was decreased when using CFI (75.7 ± 43.7 min for CFI vs. 80.1 ± 27.1 min for TI). 22 Meanwhile, Piccioli found a mean duration of procedure of 69 min (range 40−130 min) with intraoperative hemoglobin loss ranging from 0.3 to 3.5 g/dL and averaging 1.75 g/dL. 21 Piccioli et al also give the most comprehensive review of perioperative complications with 7 intraoperative (4 loss of reduction, 2 fracture dislocation, 1 metaphyseal stress fracture distal to nail), 4 early postoperative wound complications (3 wound dehiscence, 1 ischemic wound failure), and 2 late postoperative complications (1 stress fracture proximally to distal static screw, 1 screw loosening and mobilization).…”