The risk of loosening of extramedullary fracture fixation devices

Extramedullary devices that use screws, pins or wires are used extensively to treat fractures in normal and diseased bone. A common failure mode is implant loosening at the bone-screw/pin/wire interface before fracture healing occurs. This review first considers the fundamental mechanics of the bone-fixator construct with focus on interfacial strains that result in loosening. It then evaluates the time-independent and time-dependent material models of bone that have been used to simulate and predict loosening. It is shown that the recently developed time-dependent models are capable of predicting loosening due to cyclic loads in bone of varying quality.