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Abstract:
Implant breaking destabilizing the fracture may be caused by its structural defect, inappropriate use, or massive overloads. We present the patient, who broke the plate stabilizing comminuted clavicular fracture at the sixth postoperative week due to the, primarily reported, simple loading of the limb that should not exceeded admissible limits. Macroscopic examination excluded its manufacturing defect of an explant, but revealed areas of fatigue fractures, as well as anterior and inferior bending of its edges. Mechanical analysis proved sufficient material durability. Those findings clearly showed that the plate broke in consequence of repetitive overloads exceeding its durability. Patient, when acquitted with those results, confessed that the plate broke, while fishing. Moreover, he reported an episode of alcohol overuse that could contribute to implant failure bringing the risk of additional injury. Biomechanical analysis confirmed that mechanical loads throwing the spinner exceed values adequate for plate breaking. Thus, the real circumstances of the complication seem to be unveiled pointing out to facts that some patients disobey postoperative recommendations to avoid overloading of stabilized extremity, thus participating actively in this type of complications, that they dissemble the real circumstances of the complications, and that they may exhibit risky and irrational behavior. Basing on the presented case we concluded that in some cases plaster cast immobilization supporting stabilized fracture may be beneficial precluding banned activities and preventing from secondary injuries reducing the risk of postoperative complications.

Keywords:
clavicle fracture, implant failure, mechanical overloads, postoperative recommendations disobey, insubordinate patient

Abstract:
Implant fractures complicate orthopaedic procedures requiring secondary surgeries. However, it is not exactly known when the damage initiation starts and which factors predispose them to the highest degree. Thus, the aim of the study was to characterize changes observed in orthopaedic implants after their removal from the bone. Particular efforts were made to determine, which of them occur during the process of its production, installation, usage and removal. Such identification enabled to specify the role of lesions emerging during each period and their role in the implant’s deformation or fracture. The paper was focused on implants dedicated to the stabilization of the femur fractures since the bone transfers the highest loads. External surface and geometric features of eight representative implants were observed under standard and stereoscopic cameras, as well as under light and scanning electron microscopes. Macroscopic analysis of the investigated implants exhibited a number of defects in the form of scratches, abrasions, deformations and chipping. The wear degree of each implant was different and strictly depended on how it was implanted in the patient’s body, as well as on how the patient exploited it through his mobility. Four different sources of implant integrity changes were identified: manufacturingrelated changes, implant application-related changes, daily life-related changes and implant removalrelated changes.

Keywords:
Orthopaedic implants, implant’s destruction, intramedullary nail, bone plate, surface analysis, wear