Why did this fracture fail to heal? That is the question surgeons ostensibly face. And what do we do next? This episode is about nonunion, construct failure, and the biomechanics of revision surgery.
Most fixation failures are not really implant failures. They are failures of the interaction between biology, mechanics and time.
When assessing broken bones (or fusions, osteotomies, etc) we have to appreciate that achieving the result of bone healing is a balance between mechanical and biologic forces. Too much or too little of either is not beneficial, and occasionally is deleterious. Modern orthopedic approach is to control the influence of both. We do this with a deep reservoir of materials, implant choices, implant constructs, biologic augmentation materials, and careful assessment of critical points in the healing process.
It is no longer acceptable to wonder why a bone did not heal or a fixation construct failed. With a keen understanding of fixation principles, the answer should be obvious. Then undertaking revision involves a strategy to reverse what plagued the initial attempt.