Peri-implant fractures—associated with plate osteosynthesis

Abstract

Reasons for failure of plate osteosynthesis: Not uncommonly, the management of plate fixation failure can pose a challenge for the surgeon. Therefore it is first necessary to recognize the underlying reason and to address it in the context of a correct therapy strategy. Peri-implant fractures at the end of the plate, screw breakage or loosening as well as plate breakage at the site of the initial fracture line can lead to failure of the plate fixation construct. Commonly, a secondary fracture at the end of the plate is caused by an adequate force impact in mostly younger male patients in an employable age. On the other hand, in geriatric patients brittle fractures due to a low impact in inadequate accidents are seen at an increasing rate resulting from a generalized fragility of osteoporotic bone. However, in most cases the mechanical failure of plate osteosynthesis is the result of plate breakage or screw loosening based on a delayed bone fracture union. Therapy: Numerous options for internal fixation are available to readdress the instability, ranging from additional plating through intramedullary nailing to conversion to endoprosthetic arthroplasty at an appropriate fracture location near a joint. The choice of treatment should depend on the type of plate failure as well as the individual bone quality. In cases of delayed fracture union, the surgical treatment should imperatively focus on measures to support fracture healing.