Failed Plate Fixations In Fracture And Countermeasure

Objective To improve the therapeutic effect of using of plates and screws and increase knowledge of correctly using of plates and screws by retrospective analysis of failed plate fixations in fracture cases.Methods Through retrospective analyzing 47 cases of failed plate fixations in fracture cases from July 1997 to April 2009, to find and analyze the causes of failure, such as plates and screws loosening, nonunion or delayed union of fractures, exposure of plates and screws and so on.Results In 18 cases of plates and screws loosening (4 cases combined nonunion or delayed union of fractures), 4 cases were due to wrong choices of internal fixation devices(l case combined nonunion or delayed union of fracture), 3 cases were due to poor reduction (2 cases combined nonunion or delayed union of fractures, including 1 case without bone transplantation in primary operation), 1 case was due to excessive weight loading in early stage, 3 cases were due to weight loading early combined no bone transplanting in primary operation(l case combined nonunion or delayed union of fracture), 1 case was due to violating principles of combination application common screws and locked screws, 3 cases were due to excessively stripping soft tissue of fractures for unnecessary anatomical reduction, 3 cases were due to incorrect places of DHS capital nail.In 27 cases of nonunion or delayed union of fractures(4 cases combined broken or loosening of plates and screws),8 cases were due to poor reduction(l case was probably owing to original severe trauma), 14 cases were due to excessively stripping soft tissue of fractures for unnecessary anatomical reduction(1 case was probably owing to original severe trauma, 1 case was owing to wrong choice of internal fixation device), 2 cases were due to wrong choices of internal fixation devices, 1 case was due to no bone transplanting in primary operation, 1 case was due to premature weight loading, 1 case was due to incorrect reduction in operation.In other 6 cases of exposure of plates and screws, 1 case was due to poor place of plate, 4 cases were due to wound infection, 1 case was due to active pulmonary tuberculosis accompanied with original severe trauma.Conclusion The success of plate internal fixation of fracture is based on full grasp of the internal fixation principles, for example, correctly choosing plate and screw according to position and type of fracture,correctly and normatively applying internal fixation technique according to function of internal fixation device, emphasizing the protection of blood-supply of bone, periosteum and soft tissue, using the indirect reduction technique to achieve biological fixation and so on.At the same time, early and safe rehabilitation exercise should be performed, excessive and improper exercises of affected extremity should be prohibited.