Fatigue fracture of a femoral sliding compression screw-plate device after bone union

A failure of a femoral screw compression plate is described, the first such case to be reported after bone union. A fatigue fracture had started from an internal screw thread, near a keyway. Design improvements, such as lengthening the barrel around the lag screw, are suggested. The question as to whether keyways are necessary for the function of such devices is discussed. The morbidity of removal operations in elderly patients means that fatigue life improvements are needed, to avoid increasing numbers of failed implants in the continuing epidemic of fractures of the proximal femur.