title: [Titanium or steel as osteosynthesis material : Systematic literature search for clinical evidence].
abstract: BACKGROUND
  The selection of the appropriate implant material, stainless steel or titanium, is still the decision of the surgeon and/or the affiliated institution. Additionally, remarkable international differences can be found between the different markets, which cannot really be explained.
  
  
  OBJECTIVE
  A systematic literature search was performed to verify whether there is clinical evidence for the preference of one material over the other.
  
  
  METHODS
  The systematic literature search was performed utilizing the internet databases PubMed, Cochrane and Web of Science. Comparative studies were included that reported on adult patients with osteosynthesis of extremities after trauma using either stainless steel or titanium implants. Information was extracted about infection rates, incidence of clinically relevant allergies, problems with implant removal and other complications.
  
  
  RESULTS
  A total of 18 publications were identified to be eligible and 2 referenced articles were added. In summary, there is insufficient clinical evidence that the use of titanium or steel implants has a positive or negative effect on fracture healing, shows different rates of allergies, different rates of infections or mechanical failure. No supporting evidence could be identified for the difficulties with removal of titanium implants reported by surgeons.
  
  
  CONCLUSIONS
  This systematic literature search did not provide any clinical evidence for material-related differences between titanium or stainless steel implants for fracture fixation. Based on the current clinical evidence both titanium and steel implants can be considered to be of equal value. The reported difficulties with implant removal are not reflected in the published literature.
authors.affiliation: AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Dübendorf, Schweiz. alexander.joeris@aofoundation.org.
authors.forename: Alexander
authors.initials: A
authors.lastname: Joeris
authors.affiliation: AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Dübendorf, Schweiz.
authors.forename: Sabine
authors.initials: S
authors.lastname: Goldhahn
authors.affiliation: AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Dübendorf, Schweiz.
authors.forename: Elke
authors.initials: E
authors.lastname: Rometsch
authors.affiliation: BG Kliniken Ludwigshafen und Tübingen, Tübingen, Deutschland.
authors.forename: Dankward
authors.initials: D
authors.lastname: Höntzsch
mesh_terms: D015897:Comorbidity; D003877:Dermatitis, Contact / Q000453:epidemiology* / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D013232:Steel; D014025:Titanium / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D013232:Steel; D014025:Titanium
keywords: Allergies; Fracture; Implant removal; Infection rate; Mechanical complication rates