Bruce Harris Ziran1, Erin Kathleen O'Pry2, Robert Mitchell Harris3. 1. The Hughston Clinic, Atlanta, GA. 2. OMS IV, Philadelphia College of Osteopathic Medicine, Atlanta, GA; and. 3. Jack Hughston Memorial Hospital, The Hughston Clinic, Columbus, GA.
Abstract
OBJECTIVES: 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. DESIGN: Longitudinal cohort evaluated retrospectively comparing 2 periods using 2 implant types. SETTING: Single surgeon series at one Level II Trauma Center. PATIENTS: Standardized treatment protocol. Fifty-six tibial fracture patients suitable for intramedullary nailing over 5-year period. INTERVENTION: First period-TN; second period-CFN. MAIN OUTCOME: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: 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. DESIGN: Longitudinal cohort evaluated retrospectively comparing 2 periods using 2 implant types. SETTING: Single surgeon series at one Level II Trauma Center. PATIENTS: Standardized treatment protocol. Fifty-six tibial fracturepatients suitable for intramedullary nailing over 5-year period. INTERVENTION: First period-TN; second period-CFN. MAIN OUTCOME: 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. RESULTS: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. CONCLUSIONS: 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.
Authors: Gregory B Lowen; Katherine A Garrett; Stephanie N Moore-Lotridge; Sasidhar Uppuganti; Scott A Guelcher; Jonathan G Schoenecker; Jeffry S Nyman Journal: J Biomech Eng Date: 2022-05-01 Impact factor: 2.097