A Unique Case of a Titanium Plate Failure Following Osteosynthesis of a Forearm Fracture

Abstract

A 52-year-old woman suffered comminuted fractures of both the radius and ulna that were treated surgically with internal fixation with titanium plates and screws. The immediate postoperative X-rays revealed a longitudinal crack of the proximal part of the ulnar plate without loss of reduction. Therefore a protective above-elbow splint was applied for 2 months in order to facilitate fracture healing. Follow-up radiographs displayed propagation of the crack finally leading to a transverse fracture in the middle of the plate and subsequent pseudarthrosis of the ulnar fracture that required a new fixation and grafting. Plate analysis failed to reveal any material defect. Electron microscope scanning showed that appearance of the longitudinal crack was typical of a brittle fracture, while the transverse crack displayed characteristics of a fatigue fracture. Titanium brittleness and softness have been implicated in titanium implant failure. The above described configuration and especially the longitudinal crack is extremely unusual. Experimental evidence suggests that the longitudinal crack was the result of a brittle fracture. This eventually caused implant failure that subsequently led to the transverse fatigue fracture.