Nonunion and metal failure as a complication may occur in femoral fractures, which are treated with plate and screw or intramedullary nail. The authors clinically reviewed metal failure patients from initial operation to rehabilitation program, and analyzed the cause of failure and attempted to establish more rational methods of management and prevention.

Seventeen patients of metal failure, treated at Kyungpook National University Hospital from 1989 to 1998, were included in this study. We studied the relationship between the initial site of fracture, type of fracture, time interval of metal failure, configuration of metal failure, probable cause of metal failure, and secondary reconstructive operation for metal failure.

Dynamic compression plate was the most frequently (12cases) used implant. The most common site and type of fracture were proximal 1/3 of femoral shaft (8cases) and transverse fractures (11cases). As the configuration of metal failure, breakage of the plate or nail were more common at proximal or distal 1/3 of the shaft. There was no relationship between the time interval of metal failure and the initial site or type of fracture. The most probable cause of metal failure was improper rehabilitation in 6 cases (75%), other causes were another source of external force, inadequate bone support, improper choice of implant and infection.

To prevent metal failure, we must preserve the periosteum and soft tissue, use bone-grafting at the time of treatment and employ cooperative rehabilitation therapy to implement gradual increasing non-weight bearing joint exercise, partial-and full-weight bearing excercise.