The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Plate Breakage Following Internal Fixation of Long Bone Diaphyseal Fractures: A 150-Case Analysis

Document Type : RESEARCH PAPER

Authors
Yan-Zi Liu 1
Wei Zhu 2
Xue-dong Tian 1
1 Department of Orthopedic Surgery, Zibo Hospital of Traditional Chinese Medicine (Zibo Orthopedic Hospital), Zibo, Shandong, China
2 Department of Ophthalmology Surgery, Zibo Central Hospital, Zibo, Shandong, China
10.22038/abjs.2024.76775.3550
Abstract
Objectives: This study analyzed cases of plate breakage following internal fixation of long bone diaphyseal fractures to identify contributing factors and inform clinical practice.
Methods: A retrospective analysis of 150 plate breakage cases after diaphyseal fracture fixation was conducted using data from the "DXY" forum in November 2023. Patient demographics, fracture characteristics, plate specifications, surgical techniques, and outcomes were evaluated.
Results: Plate breakages occurred most frequently in the femur (67.3%), predominantly in wedge or multifragmentary fractures (60.7%). Locking plates were used in 64.7% of cases. Despite high rates of anatomical reduction (87.9% in complex fractures), plate failures occurred at an average of 11.3 months post-operation. High screw density (0.83-0.89 screws used/total holes) was observed across fracture types. In femoral fractures, the fracture zone length to working plate length ratio was notably high (0.91), indicating a relatively short working length.
Conclusion: Findings suggest that prioritizing anatomical reduction and rigid fixation may contribute to plate breakage, potentially due to impaired biological healing. Adherence to contemporary AO principles, emphasizing relative stability and biological fixation techniques, may be crucial in preventing these complications. The study highlights the need for a balanced approach between mechanical stability and biological considerations in fracture management.
        Level of evidence: IV
Keywords
Biological fixation
Biomechanics
Fracture healing
Implant failure
Surgical technique
Subjects
  1. Uhthoff HK, Poitras P, Backman DS. Internal plate fixation of fractures: short history and recent developments. J Orthop Sci. 2006; 11(2):118-26. doi:10.1007/s00776-005-0984-7.
  2. Kim T, See CW, Li X, Zhu D. Orthopedic implants and devices for bone fractures and defects: Past, present and perspective. Engineered Regeneration. 2020; 1:6-18. doi: 10.1016/j.engreg.2020.05.003.
  3. Sharma A, Kumar A, Joshi G, John JT. Retrospective study of implant failure in orthopaedic surgery. Med J Armed Forces India. 2006; 62(1):70-72. doi: 10.1016/S0377-1237(06)80164-4.
  4. Li J, Qin L, Yang K, et al. Materials evolution of bone plates for internal fixation of bone fractures: A review. J Mater Sci Technol. 2020; 36:190-208. doi: 10.1016/j.jmst.2019.07.024.
  5. Lv H, Chang W, Yuwen P, Yang N, Yan X, Zhang Y. Are there too many screw holes in plates for fracture fixation? BMC Surg. 2017; 17(1):46. doi: 10.1186/s12893-017-0244-8.
  6. Neumann MV, Strohm PC, Reising K, Zwingmann J, Hammer TO, Suedkamp NP. Complications after surgical management of distal lower leg fractures. Scand J Trauma Resusc Emerg Med. 2016; 24(1):146. doi: 10.1186/s13049-016-0333-1.
  7. Buckley RE, Moran CG, Apivatthakakul T. AO Principles of Fracture Management. 3rd ed. Stuttgart: Thieme; 2017.
  8. Soubeyrand M, Wassermann V, Hirsch C, Oberlin C, Gagey O, Dumontier C. The middle radioulnar joint and triarticular forearm complex. J Hand Surg Eur. 2011; 36(6):447-454. doi: 10.1177/175319341039697.
  9. Gardner MJ, Evans JM, Dunbar RP. Failure of fracture plate fixation. J Am Acad Orthop Surg. 2009; 17(10):647-657. doi: 10.5435/00124635-200910000-00007.
  10. Claessen FM, Braun Y, Peters RM, Kolovich GP, Ring D. Plate and screw fixation of bicolumnar distal humerus fractures: factors associated with loosening or breakage of implants or nonunion. J Hand Surg Am. 2015; 40(10):2045-2051. e2. doi: 10.1016/j.jhsa.2015.07.009.
  11. Fouda N, Mostafa R, Saker A. Numerical study of stress shielding reduction at fractured bone using metallic and composite bone-plate models. Ain Shams Eng J. 2019; 10(3):481-488. doi:10.1016/j.asej.2018.12.005.
  12. Nassiri M, MacDonald B, O’Byrne JM. Locking compression plate breakage and fracture non-union: a finite element study of three patient-specific cases. Eur J Orthop Surg Traumatol. 2012; 22:275-281. doi: 10.1007/s00590-011-0834-6.
  13. Sommer C, Babst R, Müller M, Hanson B. Locking compression plate loosening and plate breakage: a report of four cases. J Orthop Trauma. 2004; 18(8):571-577. doi:10.1097/00005131-200409000-00016.
  14. Wang J, Zhang X, Li S, et al. Plating System Design Determines Mechanical Environment in Long Bone Mid-shaft Fractures: A Finite Element Analysis. J Invest Surg. 2020; 33(8):699-708. doi:10.1080/08941939.2019.1567875.
  1. Wenger DR, Varley ES. Evidence-based Orthopaedics: The Best Answers to Clinical Questions. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.
  2. Liu GQ, Wang WJ, Shi HP, Sun K. Therapeutic effect and safety of elastic intramedullary nail versus plate fixation in repair of fracture of forearm: a meta-analysis. Chin J Tissue Eng Res. 2014; 18(26):4248-4253. doi: 10.3969/j.issn.2095-4344.2014.26.027.

  17.Daher M, Tarchichi J, Zalaquett Z, Casey JC, Ghanimeh J, Mansour J. Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis. Arch Bone Jt Surg. 2024; 12(8):535-545. doi: 10.22038/ABJS.2024.78871.3623.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 3
March 2025
Pages 146-151

  • Receive Date 16 December 2023
  • Revise Date 19 November 2024
  • Accept Date 20 November 2024