• Alexander Joeris, Sabine Goldhahn, Elke Rometsch, and Dankward Höntzsch.
• AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Dübendorf, Schweiz. alexander.joeris@aofoundation.org.
• Unfallchirurg. 2017 Feb 1; 120 (2): 96-102.

BackgroundThe 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.ObjectiveA systematic literature search was performed to verify whether there is clinical evidence for the preference of one material over the other.Material And MethodsThe 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.ResultsA 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.ConclusionThis 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.

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