Surgeons' perspective on the use of carbon fibre plates for extremity fracture fixation.

Introduction/purpose: Carbon fibre plating (CFR-PEEK) became available to orthopaedic surgeons in 1998 as a competitor to the traditional metal implants. Despite this, the use of such implants has been limited globally. The aim of this study was therefore to explore the barriers to more widespread use of CFR-PEEK, specifically by examining orthopaedic surgeons' perceptions and opinions of its use through a cross-sectional survey.

Methods: An online questionnaire with basic information attached regarding similarities and differences between CFR-PEEK and metal implants was sent out internationally, with 106 responses gained from 26 countries. Specific questions were asked to ascertain orthopaedic surgeons' current knowledge of advantages and disadvantages of CFR-PEEK, the barriers they perceive to its more widespread use, and own personal preferences. Free-text responses were analysed and the results discussed.

Results: A minority of orthopaedic surgeons surveyed would choose CFR-PEEK over traditional metal implants (10.38%). The most common disadvantage of CFR-PEEK reported was increased cost, with 46.23% respondents identifying this. Concerns regarding structural integrity of the implant were second most commonly perceived disadvantage, with 34% of surgeons citing one or more of 'stiffness/breakage/durability/contourability' as a disadvantage. A small number of surgeons (3.8%) listed unfamiliarity as a potential disadvantage to the use of carbon fibre plates. The main barrier identified to their use was poor knowledge (education) in relation to the properties and existing evidence of their performance.

Conclusions: More work is needed to make CFR-PEEK more acceptable to surgeons including examination of perceived increased cost and increasing education of these implants. Further high-level evidence confirming carbon fibre non-inferiority may increase the usage of CFR-PEEK for extremity fracture fixation in the future.