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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

Abstract:
The principal features essential for the success of an orthopaedic implant are its shape, dimensional accuracy, and adequate mechanical properties. Unlike other manufactured products, chemical stability and toxicity are of increased importance due to the need for biocompatibility over an implants life which could span several years. Thus, the combination of mechanical and biological properties determines the clinical usefulness of biomaterials in orthopaedic and musculoskeletal trauma surgery. Materials commonly used for these applications include stainless steel, cobalt-chromium and titanium alloys, ceramics, polyethylene, and poly(methyl methacrylate) (PMMA) bone cement. This study reviews the properties of commonly used materials and the advantages and disadvantages of each, with special emphasis on the sensitivity, toxicity, irritancy, and possible mutagenic and teratogenic capabilities. In addition, the production and final finishing processes of implants are discussed. Finally, potential directions for future implant development are discussed, with an emphasis on developing advanced personalised implants, according to a patient’s stature and physical requirements.

Keywords:
orthopaedic surgical procedures, biomaterials, implants, biocompatible materials, alloys, ceramic, polyethylene

Abstract:
The number of overweight and obese patients in developed countries is gradually increasing. It was reported that 1287 (64%) out of 2007 adults operated on in 2017 had a body mass index (BMI) greater than 25 kg/m2, and 26.4% even greater than 30, while the BMI of the most obese patient was as high as 57.6 kg/m2. Such distressing statistics raised an issue related to the inadequate durability of implants used for the fixation of bone fractures. Implants for the lower-extremity fractures may not be durable enough to fit the requirements of overweight and obese patients. This case report presents the history of a 23-year-old obese male with a BMI of 38.7, who bent the angularly stabile titanium plate stabilizing his broken lateral ankle and torn distal tibiofibular syndesmosis. Biomechanical analysis showed that the maximal static bending moment registered during one-leg standing was equal to 1.55 Nm. This value was circa one-third of the maximally admissible bending moment for this particular plate (5.34 Nm) that could be transmitted without its plastic deformation. Since dynamic forces exceed static ones several (3–12) times during typical activities, such as walking, climbing the stairs, running, and jumping, unpredictable forces may occur and increase the risk of loosening, bending, and even breaking implants. None of these situations should have occurred for the typical patient’s body mass of 75 kg, or even for the analyzed mass of the young patient (120 kg) who tried to avoid excessive loading during his daily routine. Subsequent implant bending and destabilization of the fracture shows that for the significantly high and still growing number of obese patients, a very strict physical regime should be recommended to prevent overabundant dynamic loads. On the other hand, the geometry of implants dedicated to these patients should be reconsidered.

Keywords:
ankle injuries surgery, bone plate, obesity, postoperative complications, implant failure

Abstract:
In this paper, fracture behavior of four types of implants with different geometries (pure titanium locking plate, pure titanium femoral implant, Ti-6Al-4V titanium alloy pelvic implant, X2CrNiMo18 14-3 steel femoral implant) was studied in detail. Each implant fractured in the human body. The scanning electron microscopy (SEM) was used to determine the potential cause of implants fracture. It was found that the implants fracture mainly occurred in consequence of mechanical overloads resulting from repetitive, prohibited excessive limb loads or singular, un-intendent, secondary injures. Among many possible loading types, the implants were subjected to an excessive fatigue loads with additional interactions caused by screws that were mounted in their threaded holes. The results of this work enable to conclude that the design of orthopedic implants is not fully sufficient to transduce mechanical loads acting over them due to an increasing weight of treated patients and much higher their physical activity.

Keywords:
medical fixation devices, orthopedic prostheses and implants, titanium, titanium alloy, stainless steel, microscopic fracture analysis