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J Am Acad Orthop Surg, Vol 17, No 10, October 2009, 647-657.
© 2009 the American Academy of Orthopaedic Surgeons
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Failure of Fracture Plate Fixation

Michael J. Gardner, MD, Jason M. Evans, MD and Robert P. Dunbar, MD

Dr. Gardner is Assistant Professor, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO. Dr. Evans is Assistant Professor, Department of Orthopaedic Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, TX. Dr. Dunbar is Assistant Professor, Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA.

Dr. Gardner or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Smith & Nephew, is a paid consultant to or is an employee of Synthes and Expanding Orthopedics, Inc, and has received research or institutional support from Synthes and Smith & Nephew. Dr. Dunbar or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Synthes and AO, and has received research or institutional support from AO, Arthrotek, Arthrocare, DePuy, Medtronic, Medtronic Sofamor Danek, Musculoskeletal Transplant Foundation, Smith & Nephew, Stryker, Synthes, and Zimmer. Neither Dr. Evans nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Gardner, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110.

Failure of fracture fixation after plating often leads to challenging surgical revision situations. Careful analysis of all patient and fracture variables is helpful in both determining the causes of the fixation failure and maximizing the success of subsequent interventions. Biologic and mechanical factors must be considered. Biologic considerations include traumatic soft-tissue injury and atrophic fracture site. Common mechanical reasons for failure include malreduction, inadequate plate length or strength, and excessive or insufficient construct stiffness. Reliance on laterally based implants in the presence of medial comminution may be a cause of fixation failure and subsequent deformity, particularly with conventional nonlocking implants. Management of dead space with cement or beads has been effective in conjuction with staged approaches. An antibiotic cement rod in the diaphysis may provide fracture stabilization. Locking full-length constructs should be considered for osteoporotic fractures.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.