Catastrophic failure of a titanium locking plate in a proximal humeral fracture: case report and literature review

BACKGROUND: Angular stable locking plates have shown good clinical results in treating proximal humeral fractures, but complications are not uncommon. This study reported a rare case of catastrophic failure of a titanium locking plate. A retrieval analysis of the implants was performed using an optic microscope and a scanning electron microscope. CASE PRESENTATION: A 69-year-old male reported a right proximal humeral fracture at the surgical neck and was treated by open reduction and internal fixation with a locking plate system. Ninety-six days after surgery, the patient came to clinic for acute local pain over the shoulder without any trauma. The radiographs showed a complete breakage of the implant accompanying displaced fracture. Revision surgery was performed to restabilize the fracture with a longer locking plate. The follow-up radiographs at 9 months showed complete union of the bone fracture. CONCLUSIONS: From the retrieval analysis, repetitive torsion loads on the vulnerable area of the implant are assumed to cause this catastrophic event. It is recommended that adequate activity restriction, such as reaching, be undertaken to avoid this rare complication. Current study also provides contributive information for the modification of plate design and pre-operative planning for device configuration to improve the success rate of locking plate fixation.