Standard titanium nails (TN) or carbon fiber–reinforced PEEK nails (CFN) were compared to evaluate impact of material on fracture union, healing time, knee/ankle, and barometric pain.
Longitudinal cohort evaluated retrospectively comparing 2 periods using 2 implant types.
Single surgeon series at one Level II Trauma Center.
Standardized treatment protocol. Fifty-six tibial fracture patients suitable for intramedullary nailing over 5-year period.
First period—TN; second period—CFN.
Measurements: standard demographic data: OTA/AO fracture classification, fracture location, and nail type. Outcome parameters: cumulative healing at standard time intervals, infection/nonunion, associated injuries, knee/ankle, barometric pain, and implant removal. Statistical analysis comparing incident healing.
Patient populations were not statistically different regarding demographics and fracture type/location, although there was a trend toward greater fracture severity/more associated injuries in CFN group. In 56 patients, 26 received CFN and 30 received TN. Healing rates were reported at each time interval. 8 weeks: TN—0%, CFN—19%; 12 weeks: TN—17%, CFN—69%; 16 weeks: TN—57%, CFN—92%; 20 weeks: TN—87%, CFN—96%; and 24 weeks: TN—97%, CFN—96% (P < 0.0001 every interval except 24 weeks). Each group had one infected nonunion in an open fracture that healed with subsequent treatment. There was a trend toward less barometric pain with CFN that did not reach statistical significance (P = 0.065). No statistical differences with knee/ankle pain (P = 0.109)/removal of implant (P = 0.269) potentially due to low power of pilot study.
In this pilot study evaluating CFR-PEEK intramedullary nail for tibial shaft fractures, there was a demonstrated accelerated healing times compared to titanium with a potential for less barometric pain.
Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.