Carbon Fiber–Reinforced PEEK Versus Titanium Tibial Intramedullary Nailing: A Preliminary Analysis and Results

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:Measurementsstandard demographic dataOTA/AO fracture classification, fracture location, and nail type. Outcome parameterscumulative 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 weeksTN—0%, CFN—19%; 12 weeksTN—17%, CFN—69%; 16 weeksTN—57%, CFN—92%; 20 weeksTN—87%, CFN—96%; and 24 weeksTN—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.