Breakage and loosening of internal fixators in the hip: Cause analysis of 22 cases

Abstract

AIM:To explore the causes of postoperative breakage and loosening of internal fixators in the hip.

METHODS: From June 1998 to September 2006, 245 cases of hip fracture, who were treated with internal fixation in Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University and 120 cases diagnosed in this hospital were retrospectively analyzed. There were 20 cases with internal fixators loosened or broken including screw loosening in 9 cases, screw breakage in 5, and plate broke in 8. During the postoperative follow up, ①the internal fixators were found broken from 3 to 38 months (mean of 15.5 months) postoperatively. And most of the patients were found with pain, claudication, dysmelia before the fixator failure; ②The breakage, loosening of internal fixators were displayed in the X-ray: plates broke in the connection site of the plate and screw, and the angulation of the plate; 4 screws broke in the initiations of the screw threads; 1 broke in screw thread; the loosened screws prolapsed backwardly to different degrees. ③There was no infection, inflammation reaction or rejection in the wound except one case with rejection.

RESULTS: The reasons for the breakage and loosening of internal fixators in the hip included: ①Unreasonable choice of internal fixators; ②Deficiency design of pedicle screw; ③severe bone defect or poor bone quality, and no bone graft or poor quality of bone fusion; ④Poor quality of the reduction; ⑤Neglect of postoperative treatment.

CONCLUSION: According to the different conditions of patients, the proper internal fixators, necessary bone graft and external fixators protection during postoperative rehabilitation are valuable procedures for the prevention of implant breakage and loosening.

Ming JH, Jia ZH, Zhou JL, Fang HB, Ma YG.Breakage and loosening of internal fixators in the hip: Cause analysis of 22 cases.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(4):713-716(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-4/4k-713(ps).pdf]

摘要
目的：分析髋部骨折后应用内固定术后内固定物断裂及松动的原因。
方法：对1998-06/2006-09武汉大学人民医院骨外科手术245例和外院手术来武汉大学人民医院就诊的120例髋部骨折患者资料进行回顾性分析，22例患者出现内固定物断裂或松动：其中9例螺钉松动，5例螺钉断裂，8例钢板断裂。术后随访情况为：①患者从内固定术后到发现内固定断裂的时间为3～38个月，平均为15.5个月，大多数患者在内固定物断裂被发现之前出现髋部疼痛不适、跛行、患肢畸形等临床表现。②X射线片示内固定断裂或松动：其中钢板断裂的部位均为钉板相接部位和钢板成角处；4例螺钉断于螺纹起始部，1例螺钉断于螺纹部；松动的螺钉均表现为不同程度的向后脱出。③术后除1例排异反应外，无切口感染、局部炎症反应、排异反应。
结果：髋部骨折内固定术后内固定物断裂及松动的原因有：①内固定器材选用不合理。②内固定物本身设计缺陷。③骨缺损严重或骨质量不佳，同时未行一期植骨或植骨未达到标准。④骨折复位不良。⑤轻视术后疗法。
结论：针对患者的具体情况选用合适的内固定材料，必要时植骨以及术后适当的配合外固定材料，以有效的防止髋部内固定物的断裂及松动。
关键词：髋部骨折；内固定物；断裂；松动；原因；对策

明江华，贾芝和，周建林，方海滨，马永刚.髋部骨折内固定植入物的断裂及松动：22例原因分析[J].中国组织工程研究与临床康复，2008，12(4):713-716 [www.zglckf.com/zglckf/ejournal/upfiles/08-4/4k-713(ps).pdf]