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. 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.

• Periodical: Key Engineering Materials (Volume 638)
• Pages: 255-261
• DOI: https://doi.org/10.4028/www.scientific.net/KEM.638.255
• Online since: March 2015
• Authors: Catalin Cirstoiu, Razvan Ene*, Mihai Nica, Patricia Ene, Monica Cîrstoiu
• Keywords: 3D-Microscopy, Failure Analysis, Metallic Biomaterials, Microscopy, Osteosynthesis Implants

References

[1] J.A. Disegi, L. Eschbach, Stainless steel in bone surgery, Injury 31, S-D2-6, (2000).

DOI: 10.1016/s0020-1383(00)80015-7

[2] I. Antoniac, Biologically responsive biomaterials for tissue engineering, Ed. Springer, ISBN 978-1-4614-4327-8, (2013).

[3] F. Purghel, R. Badea, I. Antoniac, Medical Notion for Engineers (in romanian), Ed. Printech, Bucharest, ISBN 973-652-358-6, (2001).

[4] I. Antoniac, D. Laptoiu, A.I. Blajan, C. Cotrut, Instruments and Medical Devices (in romanian), Ed. Printech, Bucharest, ISBN 978-606-521-665-5, (2011).

[5] I. Antoniac, A. Necsulescu, G. Cosmeleata, Biomaterials and shape memory alloys, in Materials Science and Engineering Handbook (in romanian), Ed. AGIR, ISBN 978-973-720-261-1, (2009).

[6] Fini M., Aldini N.N., Torricelli P., Giavaresi G., Borsari V., Lenger H., Bernauer J., Giardino R., Chiesa R, Cigada A., A new austenitic stainless steel with negligible nickel content: an in vitro and in vivo comparative investigation, Biomaterials 24, 4929-4939, (2003).

DOI: 10.1016/s0142-9612(03)00416-2

[7] Wang K., The use of titanium for medical applications in the USA, Mater Sci. Eng. A 213, 134-137, (1996).

[8] Mihaela MA; Brandusa G; Nicolae G; Iuliac A (Iulian Antoniac), Corrosion Behaviour in Ringer Solution of Ti-Mo Alloys used for Orthopaedic Biomedical Applications, Solid State Phenomena, Volume 188 (2012) 98-101.

DOI: 10.4028/www.scientific.net/ssp.188.98

[9] Togan V., Ionita G., Antoniac I., Corrosion Behavior of Ti6Al4V Coated with SiOx by PECVD Technology, Key Engineering Materials, vol. 583, pp.22-27, (2014).

DOI: 10.4028/www.scientific.net/kem.583.22

[10] Reclaru L; Unger RE; Kirkpatrick CJ; Susz C; Eschler PY; Zuercher MH; Antoniac I; Lüthy H; Ni-Cr based dental alloys; Ni release, corrosion and biological evaluation, Materials Science and Engineering C-Materials for Biological Application 32 (2012).

DOI: 10.1016/j.msec.2012.04.025

[11] Miculescu F; Miculescu M; Ciocan LT; Ernuteanu A; Antoniac I; Pencea I; Matei E; Comparative studies regarding heavy elements concentration in human cortical bone, Dig. J. Nanomat. Biostruct. 6 (2011) 1117-1127.

DOI: 10.4028/www.scientific.net/ssp.188.37

[12] Miculescu F; Bojin D; Ciocan LT; Antoniac I; Miculescu M; Miculescu N; Experimental researches on biomaterial-tissue interface interactions, Journal of Optoelectronics and Advanced Materials, 9 (2007), 3303-3306.

DOI: 10.4028/www.scientific.net/kem.638.14

[13] I. Antoniac, M. Miculescu, M. Dinu, Metallurgical characterization of some magnesium alloys for medical applications, Solid State Phenomena, 188 (2012) 109-113.

DOI: 10.4028/www.scientific.net/ssp.188.109

[14] Antoniac I; Vranceanu MD; Antoniac A; The influence of the magnesium powder used as reinforcement material on the properties of some collagen based composite biomaterials, Journal of Optoelectronics and Advanced Materials 15 (2013) 667-672.

[15] Chen CE, Weng LH, Ko JY, Wang CJ.: Management of nonunion associated with broken intramedullary nail of the femur. Orthopedics. 31 (2008) 78.

DOI: 10.3928/01477447-20080101-07

[16] Akeson WH et al.: The effects of rigidity of internal fixation plates on long bone remodelling: a biomechanical and quantitative study. Acta Orthop. Scand 47 (1976) 241-242.

[17] Sloten, J. V., Labey, L., Van Audekercke, R., Van der Perre, G, Materials selection and design for orthopaedic implants with improved long-term performance, Biomaterials 19 (1998) 1455-1459.

DOI: 10.1016/s0142-9612(98)00058-1

[18] Pohler, O. E. M.: Degradation of metallic orthopedic implants, in Biomaterials in Reconstructive Surgery, (Ed L. R. Rubin), Mosby, London, UK, 158-228 (1983).

[19] E. Proverbio and L.M. Bonaccorsi: Microstructural Analysis of Failure of a Stainless Steel Bone Plate Implant, Practical Failure Analysis 1 (2001) 33-38.

DOI: 10.1007/bf02715331

[20] Triantafyllidis G. K., Kazantzis A. V., Karageorgiou K. T.: Premature fracture of a stainless steel 316L orteopaedic plate implant by alternative episodes of fatigue and cleavage decoherence, Engineering Failure Analysis 14 (2007) 1346-1350.

DOI: 10.1016/j.engfailanal.2006.11.010

[21] Wouters, R., Froyen, L.: Scanning electron microscope fractography in failure analysis of steels. Mater. Charact. 36 (1996) 357-364.

DOI: 10.1016/s1044-5803(96)00070-8

[22] Azevedo, C.R.F., Hippert Jr, E.: Failure analysis of surgical implants in Brazil. Eng Fail. Anal. 9 (2002) 621-633.

DOI: 10.1016/s1350-6307(02)00026-2

[23] Sharma C. A., Ashok Kumar M. G., Joshi G. R., John J. T.: Retrospective Study of Implant Failure in Orthopaedic Surgery, MJAFI 62 (2006) 70-72.

[24] R. Ionescu, I. Cristescu, M. Dinu, R. Saban, I. Antoniac, D. Vilcioiu, Clinical, Biomechanical and Biomaterials Approach in the Case of Fracture Repair Using Different Systems Type Plate-Screw, Key Engineering Materials 583 (2014) 150-154.

DOI: 10.4028/www.scientific.net/kem.583.150

[25] M. Bane, F. Miculescu, A.I. Blajan, M. Dinu, I. Antoniac, Failure analysis of some retrieved orthopedic implants based on materials characterization, Solid State Phenomena 188 (2012) 114-117.

DOI: 10.4028/www.scientific.net/ssp.188.114

[26] D. Petković, G. Radenković, M. Mitković, Fractographic investigation of failure in stainless steel orthopedic plates, Facta Universitatis, Series: Mechanical Engineering 10, (2012) 7-14.