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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.

A stainless tool steel bone drill broke during an operation on a patient and was examined. It showed two fatigue fractures, one of which had started from a sharp-edged, coarsely milled slot (fracture A1), and the other from a point on the outer sheath surface which was not subjected to particularly high stresses (fracture A2). Fatigue fracture A1 resulted from the stress concentration built up at this point as a result of the sharp edges and the coarse machining grooves. The remains of a number, which had been inscribed with an electrical engraving tool for identification purposes, were found at the point of origin of fracture A2. The material had been heated to the melting point during the engraving of the number, and multiple cracking occurred during cooling. One of these cracks led to the development of fatigue fracture A2.

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.

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.

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.

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.