Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review

Author:

Pesare Elisa1ORCID,Meschini Cesare2,Caredda Matteo2,Messina Federica2,Rovere Giuseppe2,Solarino Giuseppe1,Ziranu Antonio23

Affiliation:

1. Orthopaedics Unit, Policlinico Universitario di Bari, Department of Translational Biomedicine and Neuroscience ‘DiBraiN’, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy

2. Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

3. Department of Orthopedics, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy

Abstract

Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons’ confidence in their use.

Publisher

MDPI AG

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