Refracture through the last screw hole in plate-screw fixation of long bone

Objective:To investigate the reason of refracture through the terminal screw hole in plate-screw fixation of long bone fracture.Method:A retrospective analysis was made including the refracture,time,force,location,intra-operative finding,secondary-fixation methods and treatment outcome.Result:From the year 1997 to 2003,7 cases were treated,including 5 male and 2 female,3 femur,3 ulna and radius,1 tibia.The duration between primary and secondary fracture were 16.6 months(8 to 47 months),all the primary fractures healed clinically.The fracture force of secondary was minimal,with 7 in life falls.All refractures occurred through the terminal screw in the shaft side,where the screw penetrated two cortices.In reoperation,the bone under plate was identified atrophy.The patients were re-fixed,5 by intramedullary nail and 2 by plate-screw.After 1～2 years follow up,the refractures were re-united,and the patients got functional recovery after rehabilitation.Conclusion:The main reason of refracture through the last screw hole in plate fixation is over-stress concentration.Improving technical skill by long plate and penetrating only one cortice of the last screw may prevent this kind of refracture.