The Analysis of Main Causes of Different Osteosynthesis Implants Failure in a Series of Clinical Cases

Abstract

The study presented in this paper was conducted to assess the main causes of osteosynthesis implants failure, among which implant material defects and unstable osteosynthesis fixation occur.<b> </b>A total number of 42 patients with osteosynthesis implant failure were included in this study in the Orthopedics and Traumatology Clinic of Bucharest Emergency University Hospital. The osteosynthesis implants failure was determined using radiological examination, only the patients with the age between 18 and 60 were selected. From the total number of patient included in our study, 18 had osteosynthesis performed with open reduction and plates and screws fixation, 5 intramedullary implants with open reduction, 4 intramedullary implants with close reduction, 15 cases of fixation with locking screws. For evaluating the macroscopic and microstructural features of the failure, we use microscopically techniques like stereomicroscopy, optical microscopy and scanning electron microscopy (SEM) techniques in conjunction with radiological images. After our analysis, in 14 cases we found a correct fixation but the microscopic examination of the implant materials reveals cracks in their structure, 24 cases showed an imperfect reduction of the fracture with interfragmentary diastasis and malrotation, and 4 had inadequate size devices, where the examination of failed metallic implants revealed no structural defects in implant materials. The results of our study showed that both design errors and inappropriate surgical procedures were causes of osteosynthesis failure. Therefore, special attention should be paid to the surgical fixation procedure but also to the fixation implant materials used.