- 期刊
The Fractographic Analysis of Broken Femoral Interlocking Nails and the Exploration of Failure Mechanism
並列摘要
A fracture surface is a detailed record of implant failure which can be examined by macroscopic and microscopic fractographic analysis. From 1993 to 1994, there were three breakages of femoral interlocking nails in our hospital. Two of these were Grosse-Kempf (G-K) locking nails and the other was Russel-Taylor. One of the G-K nails was broken at the proximal end of posterior slot. The patient walked postoperatively with hyperextended knee and full weight bearing. Macroscopic and microscopic examination indicated that the fracture mode was fatigue failure and the final deforming force was an overloaded principal bending forced. The other G-K nail failed in three areas, which were located at the proximal of the two distal screw-holes, the proximal end of the posterior slot, and the ununited fracture site. Macroscopic and microscopic examination showed that fatigue failure was initiated by torsion force and the final breakage was also followed by an overloaded torsion force. The third nail, Russel-Taylor type, was broken at the fracture site of the bone, located at 3.4 cm above the proximal distal screw-hole. The nail was bent up to 60 degrees in a traffic accident and failed. The classic Cup-and-Cone fracture pattern was noted macroscopically. The dimple rupture was found microscopically. We concluded that: 1. Walking with hyperextended knee is a poor gait after intramedullary fixation for femoral shaft fracture without bony union. 2. The area in the end of proximal posterior slot is the weakest point or theweakest point or the most stress concentrated area. The augmentation of this area is indicated. 3. Early weight-bearing and nonunion of the fracture are the major causes of implant failure. 4. Fractographic analysis is a good method to analyze implant failure. If we understand the fracture mode, distribution of the stress on the nail, and the fracture path, the design of the implant in the future will be modified and certainly be improved.
延伸閱讀
- Ip, W. Y. (2002). Design and biomechanical study of internal fixation devices for difficult phalangeal fractures [master's thesis, The University of Hong Kong]. Airiti Library. https://www.airitilibrary.com/Article/Detail?DocID=U0029-1812201200003445
- Chang, K. W., Zou, D., Donovan, D. M., Edwards, W. T., Fredickson, B. E., & Yuan, H. A. (1991). Mechanics of Reduction of Intracanal Fragments of Thoracolumbar Burst Fractures. Journal of Orthopaedic Surgery Taiwan, 8(2), 123-133. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199106-8-2-123-133-a
- Wu, C. C., & Shih, C. H. (1991). The Role of an Interlocking Nail in Treatment of an Unstable Comminuted Tibial Shaft Fracture. Journal of Orthopaedic Surgery Taiwan, 8(1), 29-38. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199103-8-1-29-38-a
- Lee, M. Y., Kuo, C. H., & Hung, S. S. (2004). Implementation of a Sound-Guided Navigation System for Tibial Closed Interlocking Nail Fixations in Orthopedics. Journal of Medical and Biological Engineering, 24(3), 147-153. https://www.airitilibrary.com/Article/Detail?DocID=16090985-200409-24-3-147-153-a
- Wei, L. Y., Chang, A. H., Yeh, L. F., & Su, J. C. (1988). Treatment of Femoral Complex Fractures with the Huckstep Interlocking Nail. Journal of Orthopaedic Surgery Taiwan, 5(1), 72-85. https://www.airitilibrary.com/Article/Detail?DocID=10116923-198803-5-1-72-85-a