Titanium versus Biodegradable Implants for Fracture Fixation: A Retrospective Comparative Study

Background: Titanium alloy implants are widely used in fracture fixation due to their excellent mechanical stability, but they often require secondary surgeries for removal. In contrast, biodegradable implants eliminate the need for removal, yet concerns regarding their mechanical strength in load-bearing bones remain. This study evaluates the clinical trade-off between mechanical rigidity and the burden of secondary surgery by comparing titanium versus biodegradable implants in limb and pelvic fractures. Methods: A retrospective cohort study was conducted on 73 patients treated between November 2021 and August 2024. Patients were divided into the titanium group (n = 40, primarily diaphyseal fractures) and the biodegradable group (n = 33, primarily metaphyseal/peri-articular fractures). Outcomes including implant palpability and reoperation rates were assessed. A stratified analysis compared outcomes in weight-bearing versus non-weight-bearing fractures. Results: The mean age of patients was 42.6 ± 16.03 years. Titanium implants were associated with significantly higher rates of plate palpability (18/40, 45.0% vs 3/33, 9.1%; OR 8.18, 95% CI 2.14– 31.3; P = 0.001) and secondary surgery (14/40, 35.0% vs 3/33, 9.1%; OR 5.38, 95% CI 1.39– 20.8; P = 0.012) compared to biodegradable implants. Elective removal due to discomfort occurred in 17.5% (7/40) of titanium patients but was eliminated (0%) in the biodegradable group ( P = 0.014). In the weight-bearing subgroup, biodegradable implants significantly reduced palpability (11.1% vs 53.3%, OR 9.14) without increasing complication-driven reoperations. However, three cases (9.1%) of refracture occurred in the biodegradable group compared to zero in the titanium group ( P = 0.088). Conclusion: In this cohort, biodegradable implants were associated with a reduction in implant palpability and elective removal surgery for metaphyseal and peri-articular fractures. However, due to lower mechanical strength, titanium remains the preferred choice for diaphyseal fractures requiring high mechanical stability. These findings are limited by the retrospective design and heterogeneity of fracture sites. Keywords: titanium implants, biodegradable implants, fracture fixation, plate palpability, secondary surgery