Failed Osteosynthesis: Responsible factors, management and Its Outcome

Abstract

Objective: To examine the factors responsible for implant failures and the management outcomes in our practice 

Methods: The data of  patients with failed osteosynthesis from January 2018 to December 2020 was analyzed. Information on socio-demographics, main  presenting complaint, patients’ clinical features, indications for osteosynthesis, duration from surgery, bone involved, imaging features,  type of implant used, factors responsible for implant failures, assessment of the challenges of Management and Management outcomes were retrieved from the patients’ case files at medical record department of the hospitals. Data was subjected to analysis with SPSS  software. Patient with incomplete documentations were excluded. The inclusion criteria include all patients diagnosed with failed  osteosynthesis, who were able to provide history or had reliable informant(s) to provide history and those with detailed medical reports  from other hospitals where the osteosynthesis was done. 

Results: Fifty-three patients studied, out of which 46 (86.8%) males and 7  (13.2%) females in the age group of 7- 69 years with a mean age of 37.5 years. Fresh fracture was the highest (58.5%) indication for the  surgery that failed. The other indications were malunion (20.8%), non-union (14%) and pathological fracture (7.5%). All the patients had  operation with 32.1% of them had implant removal alone because revision was not necessary, 24.5% had revision alone while the rest  (43.4%) had exchanged implant with a biologically and biomechanically more superior implants. The study revealed that many (85%) had  satisfactory results as revision surgery. 

Conclusion: The study revealed non-compliance with post-operative protocols as the commonest  causes (28.3%) of failed implants followed by re-trauma (17%) and non-union (17%) respectively while femur is the commonest (45.3%)  bone with failed implant. Many (65%) of the patients presented with combination of symptoms which necessitated revision  osteosynthesis with a superior implant. Even though, the management of these patients were challenging but many (85%) had  satisfactory results. Orthopaedic surgeons are encouraged to review the principles to individualized the patient’s management protocols  and risk of implant failure with adequate measure to prevent