Journal of Musculoskeletal Trauma

Metal Failure after Internal Fixation in the Treatment of Femur Mid-shaft Fractures: Kyung Jin Song, Jang Yeub Jeon, Jin Ho Yoon, Myung Sik Park, Byung Yeon Hwang; J Korean Soc Fract 2002;15(3):349-355. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.349

Abstract PDF: PURPOSE
To evaluate the causative factors of metal failure after internal fixation, and to suggest more rational treatment guideline that can prevent metal failure in the mid-shaft femur fractures.
MATERIALS AND METHODS
A retrospective review of 17 cases, who were treated with internal fixation for the femur mid-shaft fracture was analyzed. We evaluated the cause of injury, fracture type and site, associated injury, used instruments, duration to metal failure, and complications.
RESULTS
The metal failure occurred on average 14.8 months after internal fixation. As extrinsic factors, early exercise and weight-bearing in 7 cases, slip down during ambulation in 4 cases, improper physical therapy in 3 cases and unknown cause in 3 cases were related to metal failure. Most metal failure were occurred at the initial fracture site in 12 cases. Other metal failure site were empty holes in 1 case and proximal area of fracture site in 1 case, and screw breakage in 3 cases.
CONCLUSION
Accurate preoperative evaluation of fracture site, fracture type and proper selection of instrument, and precise surgical technique will be essential for the prevention of metal failure.

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Metal failure after compression plate fixation in femoral shaft fracture: Sung Ho Han, Bo Kyu Yang, Chi Hong Kim, Tae Won Ahn, Dong Hyun Kim; J Korean Soc Fract 1998;11(4):732-737. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.732

Abstract PDF: Intramedullary nailing is one of the most available method in the treatment of femoral shaft fracture. Recemtly compression plate is not widly used. Inapproriate technique using compression plate lead to metal failure. The purpose of this study is to analyz the clinical feature, cause and treatment of metal ailure in femoral shaft fracture. We analyzed 6 cases of metal failure from Jan. 1990. to Dec. 1996 and obtained the following results. 1. Type of fracture were Winquist-Hansen Type I in 1 case, Type-II 3 cases, Type III 2 cases. 2. The interval between initial poeration and metal failure was 11 months on average, ranging from one to twenty months. 3. Metal failure occurred as plate breakage in 4 cases, plate bending and loosening in 2 cases. 4. Cause of metal failure after compression plate fixation presumed to be comminuted fracture in 5 cases, early weight bearing in 3 cases, remaining bone defect in 4 cases, inadequate surgical technique in 4 cases and empty plate hole in 4 cases. 5. Treatment of metal failure after compression plate fixation were intramedullary nailing with bone graft in all cases. Accturate preoperative evaluation of fracture site, fracture pattern, and appropiate selection of metal device necessary for the prevention of metal failure.

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Analysis of Metal Failures for the femur Shaft Fractures: Kyung Jin Song, Hwang Jik Kim, Jeong Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):501-508. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.501

Abstract PDF: The purpose of this investigation was to analyze the causes of the metal failures, and to suggest reasonable methods that can prevent metallic failures in the treamtnet of femur shaft fractures. There were 27 metal failures in 25 patient who underwent internal fixation for the femur shaft fracture between May of 1990 and May of 1996. We analyzed the causes of injury, fracture site, associated injury and used implants for the femur shaft fractures. And also analyzed the interval since operation to metal failure, method of treatment, and complications following surgery for the metallic failures. There were 13 stainless steel DCP(dynamic compression plate), 4 titanium LC(low contact)-DCP, 7 interlocking IM(intramedullary) nails, 2 Dutscher nails, and 1 anatomical plate. The metal failure occurred on average 6.1 months after internal fixation. Eight stainless steel DCP, 4 LC0DCP and 1 anatomical plate failed at the empty hole located at the fracture site. With interlocking IM nail, 4 cases of failure occurred at the proximal 1/3 of femur and other 3 cases showed failure on distal interlocking hole in distal femoral shaft fractures. All failures developed at the fracture site in kuntscher nail. For the treatment of metal failures, we used stainless steel DCP in 12 cases, interlocking IM nail in 7 cases, Kuntcher nail in 2 cases, Ender nail in 1 case, dual plate in 1 case, and external fixation in 2 cases. Autogenous cancellous iliac bone graft applied in 20 cases for the augmentation of frcture site or to fill the defect area. There were 2 cases of re-failure, 2 chronic osteomyelitis, 1 fracture site infection, 2 delayed union and knee joint ankylosis in 1 case. Accurate preoperative evaluation of fracture site, fracture pattern and proper implant selection will be essential for the prevention of metal failures. Minimal soft tissue dissection, anatomical reduction and rigid internal fixation will be necessary for the satisfactory outcome in the treatment of femur shaft fractures. Augmentation with autogenous cancellous bone graft should be followed after internal fixation for the comminuted fractures or bony defect over the fracture site. Postoperative rehabilitation program should be individualized according to the preoperative fracture pattern, used implant, and fracture stability.

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Metal Failure after Plate Fixation for Femur Fracture: Hee Kwon, Dong Wook Kim, Chi Soo Sohn, Seung Ryeol Yoon, Joon Min Song, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 1997;10(2):371-378. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.371

Abstract PDF

From January 1991 to August 1996, we experienced 17 cases of metal failure among 150 cases of plate fixation of femur fracture. We analyzed the cases and obtained the following results: 1. Among 17 cases, 15 cases were closed fracture and 2 cases were open fracture. In 11 cases, the fractures were located on the midshaft of femur and most of them was segmental or comminuted. According to AO classification, 14 cases(82%) were type B(B1:1, B2:4) and C(C1:7, C3:2). 2. The interval between initial operation and metal failure was 8 months on average. 3. The cause of metal failure were bone defect remaining after initial operation, fragment necrosis due to periosteal denuding of large free bone fragments, early weight bearing, selection of inappropriate implants and improper operation technique. 4. Plate breakages were occured in 11 cases and screw fractures and screw loosening in 6 cases. Most of plate breakage was due to remaining bone defects, and most of screw fractures and loosening was due to inappropriate implants and improper operation techinque. In conclusion, accurate preoperative evaluation on the fracture site, fracture pattern and appropriate selection of internal fixative are important for proper bone healing. Based upon our result, we suggest semiopen technique with minimal soft tissue injury and initial early bone graft for bone defect.

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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Metal Failure in Treatment of Fracture of Femoral Shaft: S R Park, H S Kim, K H Moon, J S Kang, W H Lee, S R Shin; J Korean Soc Fract 1996;9(1):97-104. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.97

Abstract PDF: Treatments of choice for femoral shaft fracture in adult patients are plate and screws, and intramedullary nailing. Through this active treatment, early motion exercise and early weight bearing can be obtained. However, the frequency of metal failure has increased also and has become a problem in treatment of the fracture. The authors clinically analysed the metal failure in 13 cases after fixation of femoral shaft fracture, during last 7 years since from February 1988 to January 1995. We obtained the following results; 1. The interval between initial operation and metal failure was 6.8 months on average, ranging from 2 to 13 months, and the most common site of the metal failure was previous fracture site. 2. The most common cause of metal failure was dificiency of medial buttress(8 cases, 61.5%) and the most common method of the treatment was intramedullary fixation with interlocking nail and bone graft. 3. To avoid metal failure, accurate reduction of fracture, adequate immobilization and adequate postoperative management was necessary.

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Operative Treatment on Fracture of Distal Third of Femoral Shaft: Ki Hong Choi, Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Kang Deuk Koh; J Korean Soc Fract 1990;3(1):53-61. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.53

Abstract PDF: The fracture of distal third of femoral shaft difficult to choose method of treatment and timing of wt. bearing because of increrment of communited fracture, anatomic characteristics and complication such as metal faulure, shortening and angulation. After analysis of 52 cases of fracture of distal third femoral shaft treated operatively in the Department of Orthopaedic Surgery, Ewha Womans University Hospital during 5.5yrs from. Jan. 1984 to June 1989 except pathologic fracture, the following results were obtained. 1. By Reis and Hirschberg classification, type I, II and III fracture wore seen in 16 patients (31%), 12 patients(23%) and 24 patients(46%) respectively. 2. The rate of complication was 29%(15 cases) with 46%(7 cases) of the complication related to the nature of the implant. 3. Among the 7 cases of metal faulure, four cases was caused by early wt. bearing and uncarefulness of patients in type III fracture.

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