Plate Breakage Following Internal Fixation of Long Bone Diaphyseal Fractures: A 150-Case Analysis

Abstract

Objectives: This study analyzed cases of plate breakage following internal fixation of long bone diaphyseal fractures to identify contributing factors and inform clinical practice. Methods: A retrospective analysis of 150 plate breakage cases after diaphyseal fracture fixation was conducted using data from the "DXY" forum in November 2023. Patient demographics, fracture characteristics, plate specifications, surgical techniques, and outcomes were evaluated. Results: Plate breakages occurred most frequently in the femur (67.3%), predominantly in wedge or multifragmentary fractures (60.7%). Locking plates were used in 64.7% of cases. Despite high rates of anatomical reduction (87.9% in complex fractures), plate failures occurred at an average of 11.3 months post-operation. High screw density (0.83-0.89 screws used/total holes) was observed across fracture types. In femoral fractures, the fracture zone length to working plate length ratio was notably high (0.91), indicating a relatively short working length. Conclusion: Findings suggest that prioritizing anatomical reduction and rigid fixation may contribute to plate breakage, potentially due to impaired biological healing. Adherence to contemporary AO principles, emphasizing relative stability and biological fixation techniques, may be crucial in preventing these complications. The study highlights the need for a balanced approach between mechanical stability and biological considerations in fracture management. Level of evidence: IV