Abstract
BackgroundCarbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) has superior radiolucency compared to other orthopedic implant materials, e.g. titanium or stainless steel, thus allowing metal-artifact-free postoperative monitoring by computed tomography (CT). Recently, high-resolution peripheral quantitative CT (HRpQCT) proved to be a promising technique to monitor the recovery of volumetric bone mineral density (vBMD), micro-architecture and biomechanical parameters in stable conservatively treated distal radius fractures. When using HRpQCT to monitor unstable distal radius fractures that require volar distal radius plating for fixation, radiolucent CFR-PEEK plates may be a better alternative to currently used titanium plates to allow for reliable assessment. In this pilot study, we assessed the effect of a volar distal radius plate made from CFR-PEEK on bone parameters obtained from HRpQCT in comparison to two titanium plates.MethodsPlates were instrumented in separate cadaveric human fore-arms (n = 3). After instrumentation and after removal of the plates duplicate HRpQCT scans were made of the region covered by the plate. HRpQCT images were visually checked for artifacts. vBMD, micro-architectural and biomechanical parameters were calculated, and compared between the uninstrumented and instrumented radii.ResultsNo visible image artifacts were observed in the CFR-PEEK plate instrumented radius, and errors in bone parameters ranged from −3.2 to 2.6%. In the radii instrumented with the titanium plates, severe image artifacts were observed and errors in bone parameters ranged between −30.2 and 67.0%.ConclusionsWe recommend using CFR-PEEK plates in longitudinal in vivo studies that monitor the healing process of unstable distal radius fractures treated operatively by plating or bone graft ingrowth.
Highlights
Carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) has superior radiolucency compared to other orthopedic implant materials, e.g. titanium or stainless steel, allowing metal-artifact-free postoperative monitoring by computed tomography (CT)
Whereas stable distal radius fractures are usually treated by immobilization with a fiberglass cast, which only has a limited effect on the bone parameters obtained by high-resolution peripheral quantitative CT (HRpQCT) [8], volar distal radius plates (VDRPs) as internal fixation are a generally accepted treatment in case of unstable distal radius fractures or after corrective osteotomy [9]
For the radius instrumented with the CFR-PEEK plate, percent errors in bone parameters ranged from −3.2% in Ct.Th to +2.6% in Tb.Sp, and the smallest error was observed in Trabecular density (Dtrab), with −0.8%
Summary
Carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) has superior radiolucency compared to other orthopedic implant materials, e.g. titanium or stainless steel, allowing metal-artifact-free postoperative monitoring by computed tomography (CT). When using HRpQCT to monitor unstable distal radius fractures that require volar distal radius plating for fixation, radiolucent CFR-PEEK plates may be a better alternative to currently used titanium plates to allow for reliable assessment. In this pilot study, we assessed the effect of a volar distal radius plate made from CFR-PEEK on bone parameters obtained from HRpQCT in comparison to two titanium plates. Besides reduced sensitivity of CT measurements, this may result in an over- or underestimation of the bone density, micro-architectural and biomechanical parameters that are derived from such images [10]
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