A stainless steel screw securing an orthopedic implant fractured and was analyzed to determine the cause. Investigators used optical and scanning electron microscopy to examine the fracture surfaces and the microstructure of the austenitic stainless steel from which the screw was made. The results of the study indicated that the screw failed due to fatigue fracture stemming from surface cracks generated by stress concentration likely caused by grooves left by improper machining.

Threads of a bone screw (Co-Cr-Mo alloy, type ASTM F75) had broken off, and other threads had cracked. 15x sectioning showed porosity, and 155x magnification showed gas holes, segregation, and dissolved oxides. This supports the conclusion that manufacturing defects caused the failure.

Heavy pitting corrosion on type 304 stainless steel bone screw was studied. A screw head that exhibited heavy pitting corrosion attack was observed. Deep tunnels that penetrated the screw head and followed the inclusion lines were revealed. The screw was inserted in a plate made of type 316LR stainless steel and some mechanical fretting and very few corrosion pits were revealed. Type 304 stainless steel was deemed not to be satisfactory as an implant material.

During the internal fixation, the type 316LR stainless steel cortical bone screw failed. Extensive spiral deformation was revealed by the fracture surface. Dimple structure characteristic of a ductile failure mode was observed with dimples oriented uniformly in the deformation direction. A zone of heavily deformed grains at the fracture edge was revealed by longitudinal metallographic examination. The shearing fractures of a commercially pure titanium screw and a cast cobalt-chromium-molybdenum alloy were discussed for purpose of comparison.

Bearing in mind the three-legged stool approach of device design/manufacturing, patient factors, and surgical technique, this article aims to inform the failure analyst of the metallurgical and materials engineering aspects of a medical device failure investigation. It focuses on the device "failures" that include fracture, wear, and corrosion. The article first discusses failure modes of long-term orthopedic and cardiovascular implants. The article then focuses on short-term implants, typically bone screws and plates. Lastly, failure modes of surgical tools are discussed. The conclusion of this article presents several case studies illustrating the various failure modes discussed throughout.

Two type 316L stainless steel orthopedic screws broke approximately 6 weeks after surgical implant. The screws had been used to fasten a seven-hole narrow dynamic compression plate to a patient's spine. The broken screws and screws of the same vintage and source were examined using macrofractography, SEM fractography, and hardness testing. Fractography established that fracture was by fatigue and that the fatigue cracking originated at corrosion pits. Hardness while below specification, still indicated that the screws were in the cold-worked condition and notch sensitive during fatigue loading. Use of a steel with a higher molybdenum content (317L) in the annealed condition was recommended.

This article commences with a description of the prosthetic devices and implants used for internal fixation. It describes the complications related to implants and provides a list of major standards for orthopedic implant materials. The article illustrates the body environment and its interactions with implants. The considerations for designing internal fixation devices are also described. The article analyzes failed internal fixation devices by explaining the failures of implants and prosthetic devices due to implant deficiencies, mechanical or biomechanical conditions, and degradation. Finally, the article discusses the fatigue properties of implant materials and the fractures of total hip joint prostheses.

A narrow bone plate made of type 316 stainless steel and used to stabilize an open midshaft femur fracture failed. A crack at a plate hole next to the fracture site had been revealed by a radiograph taken 13 weeks after the operation. The plate was revealed to be slightly bent in the horizontal plane, and the fracture gap was considerably open. The screws and plates supplied by different manufacturers were revealed to be different with respect to microcleanliness (primary inclusion content) of the materials and only one of them was found to be according to specifications. The local crack formation was influenced by the presence of larger inclusions. The screw failed was revealed to have failed through a fatigue mechanism by the presence of striations in the scanning electron micrograph. The crack in the plate was revealed to have originated at the upper, outer corner of the plate by the beach marks which indicated the action of asymmetric bending and rotational forces.

Stainless steel is frequently used for bone fracture fixation in spite of its sensitivity to pitting and cracking in chloride containing environments (such as organic fluids) and its susceptibility to fatigue and corrosion fatigue. A 316L stainless steel plate implant used for fixation of a femoral fracture failed after only 16 days of service and before bone callus formation had occurred. The steel used for the implant met the requirements of ASTM Standard F138 but did contain a silica-alumina inclusion that served as the initiation point for a fatigue/corrosion fatigue fracture. The fracture originated as a consequence of stress intensification at the edge of a screw hole located just above the bone fracture; several fatigue cracks were also observed on the opposite side of the screw hole edge. The crack propagated in a brittle-like fashion after a limited number of cycles under unilateral bending. The bending loads were presumably a consequence of leg oscillation during assisted perambulation.

The plate used to treat a pseudarthrosis in the proximal femur was investigated for reasons of non-progress of healing. Fatigue cracks were revealed on the top surface of the small section of the plate at the fifth screw hole. The plate was found to be heavily loaded by comparison of intensity of these structures, compared to results of systematic crack-initiation experiments. It was revealed by fatigue bending tests that the fatigue life of plates with asymmetrically arranged holes is at least as long as for plates with holes situated in the center. Fatigue began at the large section only after a fatigue crack begins to propagate into the small plate section. A large secondary crack which had developed parallel to the main crack in the center of the surface was revealed. The fifth hole was situated at the transition between the supporting bone and the defect and hence stress concentration was revealed to be high.