Complications of patients with bone tumors treated with carbon-fiber plates: an international multicenter study

Abstract

Carbon-fiber (CF) plates are a promising alternative to metal plates. However, reported experience in orthopaedic oncology remains limited. The aim of this study was to identify complications of patients with bone tumors treated with CF plates. Between February 2015 and May 2021, 13 centers retrospectively registered patients with bone tumors that were reconstructed using CF plates. Complications were identified, and timing and etiology of complications were noted. Similar complications were tabulated and classified based on mechanical, non-mechanical and paediatric complications. Mechanical complications included: (1) aseptic loosening or graft-host non-union, and (2) structural complications. Non-mechanical complications included: (3) soft tissue complications, (4) infection and (5) tumor progression. Specific paediatric complications included (6) growth arrest resulting in longitudinal or angular deformity. Ninety-six patients were included with a median follow-up time of 35 months. In total, 22 (23%) patients had complications. Mechanical complications included: 1 (1%) aseptic loosening, 2 (2%) non-unions, and 7 (7%) structural complications. Non-mechanical complications included 1 (1%) soft tissue complication, 4 (4%) infections and 5 (5%) tumor progressions. Paediatric complications occurred in 2 (2%) patients. This study suggests CF plates are safe to use in demanding reconstructions after bone tumor resections, presenting a seemingly low complication profile.

Figure 1

Giant cell tumor in the right distal femur treated with bone cement during curettage using a metal plate (a) and a carbon-fiber plate (b).

Figure 2

World map showing all 13 participating centers.

Figure 3

Flow diagram illustrating patient selection and outcomes.

Figure 4

Intraoperative picture after midshaft resection of the left humerus and partial resection of the triceps muscle due to an Ewing Sarcoma. Reconstruction was performed with a free vascularized fibula graft and a carbon-fiber humerus plate (a). Postoperative anteroposterior X-rays of the same patient (b).

Figure 5

Adamantinoma in the proximal tibia of a 10-year-old girl (a). Status after resection proximal tibia and reconstruction with humerus allograft, fibula transfer and carbon-fiber plate. Allograft-host junction healing at (b) 6 months, (c) 1-year, and (d) 2-years postoperatively. Additional surgery was performed to treat the valgus leg axis with an eight-plate 21 months after initial surgery (d).

Figure 6

Carbon-fiber plate after pathological fracture of the left distal femur due to a diffuse large B-cell lymphoma (a). Plate breakage, exactly at the location of the pathological fracture at 5 months after surgery (b). Status after revision with a conventional retrograde femoral nail (c). Pseudoarthrosis remained, and this patient died of disease 1-year after the carbon-fiber plate revision with a conventional retrograde femoral nail. In general, an intramedullary osteosynthesis of lower extremity pathological fractures is preferred because steel plates are expected to break when fracture healing is not achieved.