Comparative complication rates of titanium vs carbon fiber intramedullary nails in pathologic long bone fractures: A...

Carbon fiber (CF) intramedullary (IM) nails have emerged as a promising alternative to titanium (TI) implants for managing pathologic long bone fractures, offering advantages such as radiolucency for improved imaging, reduced artifact during surveillance, and minimal attenuation of therapeutic radiation. Although early studies suggest comparable complication rates between CF and TI constructs, existing evidence remains limited by small sample sizes and a lack of direct, high-quality comparisons of complication profiles. This study aimed to systematically compare complication rates between CF and TI IM nails for the treatment of pathologic long-bone disease secondary to malignancy.

A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines to evaluate the complication profiles of CF versus TI IM nails in patients with impending or completed pathologic long-bone fractures secondary to malignancy. Eligible studies reported on postoperative outcomes, including revision surgery, nonunion, periprosthetic fracture, implant failure, and overall complication rates. Data were analyzed using single-proportion meta-analysis and subgroup analysis in RStudio v4.5.1.

Five retrospective cohort studies comprising 361 patients (194 treated with TI nails and 167 with CF nails) met the inclusion criteria. There were no statistically significant differences between cohorts in rates of nonunion (p = 0.876), periprosthetic fracture (p = 0.834), revision surgery (p = 0.757), or total complication rates (p = 0.617). However, implant failure occurred at a higher rate in the CF group (p = 0.016), based on a limited number of events.

CF IM nails appear to demonstrate complication rates comparable to traditional TI implants in the fixation of pathologic long bone fractures secondary to bone tumors, although they may be associated with a higher observed risk of implant failure. Given the low to very low quality of available evidence and the relatively small pooled sample size of this review, these findings should be considered exploratory. Future large-scale, prospective randomized studies are warranted to confirm these findings and enhance their generalizability across diverse oncologic populations.