Failure analysis and design improvement of retrieved plates from revision surgery.

Background: The fracture of bone plate can cause considerable pain for the patient and increase the burden on the public finances. This study aims to explore the failure mechanism of 49 plates retrieved from revision surgery and introduce pure magnesium (Mg) block to improve the biomechanical performance of the plate via decreasing the stiffness and to stimulate the biological response of the plate potentially by the degradation of Mg block. Methods: The morphological analysis and component analysis of the plates were conducted to determine the fracture reason of the plates combining the clinical data. According to the structural feature, the 49 retrieved plates were divided into: traditional plate (TP), asymmetrical plate (AP), reconstructive plate (RP) and central enhancement plate (CEP), and their structure features are normalized in a commercial plate, respectively. The biomechanical performance of the plates was evaluated using a validated femoral finite element model. A block of pure Mg with a thickness of 1 mm, 1.5 mm and 2 mm was also incorporated into the CEP to be assessed. Results: The results indicated that the retrieved plates mainly failed due to fatigue fracture induced by delayed union or nonunion (44/49), and using pure titanium plates in weight-bearing areas increased the risk of fracture compared with Ti alloy plates when the delayed union or nonunion occurred. The TP demonstrated the highest compression resistance and bending resistance, while CEP had the highest rotational resistance. As the thickness of the Mg block was increased, the stress on the plate in compression decreased, but the stress in rotation increased. The plate with a 1.5 mm Mg block demonstrated excellent compression resistance, bending resistance and rotational resistance. Conclusion: Fatigue fracture resulting from the delayed union or nonunion is the primary failure reason of plates in clinic. The incorporation of Mg block into plate improves the biomechanical performance and has the potential to promote bone healing. The plate with a 1.5 mm Mg block may be suitable for use in orthopaedics. The translational potential of this article: This study assessed the failure mechanism of retrieved bone plates and used this data to develop a novel plate incorporating a 1.5 mm block of pure Mg block at the position corresponding to the fracture line. The novel plate exhibited excellent compression resistance, bending resistance and rotational resistance due to the alleviation of stress concentrations. The Mg block has the potential to degrade over time to promote fracture healing and prevents fatigue fracture of plates.