Engineering Failure Analysis 15 (2008) 521530

www.elsevier.com/locate/engfailanal

Fatigue failure of an orthopedic implant A

locking compression plate
C. Kanchanomai
a

a,*

, V. Phiphobmongkol b, P. Muanjan

Department of Mechanical Engineering, Faculty of Engineering, Thammasat University, Klong-Luang, Pathumthani 12120, Thailand
b
Department of Orthopedic Surgery, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok 10210, Thailand
Received 15 March 2007; accepted 14 April 2007
Available online 27 April 2007

Abstract
In the present work, the fatigue failure of a locking compression plate (LCP) xed across a transverse fracture (8-mm
gap) at the midshaft of femur was experimentally evaluated. The complete fracture of LCP occurred after 42,000 cycles of
loading, i.e. equivalence to about 8 days of walking. The fatigue failure of LCP was possible before the adequate healing of
fracture, and the full load of walking should not be allowed for the patient with the present fracture condition. The fatigue
crack rstly initiated from a subsurface inclusion embedded under the surface of compression hole. After some cycles of
loading, another fatigue crack also initiated from the surface of locking hole, and then both cracks propagated inside the
LCP. As an evidence of the propagation of fatigue crack, the striations were observed on the fracture surface of the LCP.
The striation spacing was long when observed far from the crack initiation site, and became shorter when observed around
the crack initiation site. Based on the striation spacing, the number of cycles for the propagation of fatigue crack from the
initiation site to the bottom part of LCP was estimated to be approximately 5000 cycles.
2007 Elsevier Ltd. All rights reserved.
Keywords: Locking compression plate; Femur; Fatigue; Crack initiation; Crack propagation

1. Introduction
The dynamic compression plate (DCP) is one of the most commonly used implants for internal xation. In
regular DCP system, the forces acting on femur are bypassed across the fracture area, thus the fracture site is
protected and the alignment is maintained throughout the healing process [1]. In order to obtain a stable xation, the screws on the DCP must be pressed or tightened into the DCP holes, which means the plate compressed the surface of bone. High amount of load will be transmitted from the screws through the bone-plate
interface. Thus, the stability of bone and plate complex is achieved. However, the existing compression force
between bone and plate may cause the vascular damage to the undersurface bone tissue, which results in unfavorable conditions for bone healing under the plate. Recently, the locking compression plate (LCP) has been
*

Corresponding author. Tel.: +66 02 564 3001; fax: +66 02 564 3010.
E-mail address: kchao@engr.tu.ac.th (C. Kanchanomai).

1350-6307/$ - see front matter 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.engfailanal.2007.04.001

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introduced by an association for the study of osteosynthesis/an association for the study of internal xation
(AO/ASIF). This new LCP has combined the advantages of compression hole of DCP with the advantages of
threaded hole by introducing combination holes [24], as shown in Fig. 1a. The threaded part of the combination hole was designed to use with a locking head screw (Fig. 1b). If the locking head screws are fastened
through the conical thread holes of LCP, the load is transmitted through screw-plate system without compression between plate and bone surface, which maintains space and preserve vascular supply to the injured bone.
On the other hand, regular screw can be used through the conventional compression hole located on the other
side of the combination hole to function as regular DCP. The LCP system is therefore possible to serve for
both purposes, i.e. compression plate system or locking plate system.
In addition to biological compatibility of LCP to treat femoral fracture, the endurance of the LCP is also
one of the crucial considerations. In fractured femur, various types of forces act on the implants and the
femur, especially cyclic load acting on implants during walking. The fatigue damage, which is a process of
defect accumulation, crack initiation, and crack propagation with number of load cycles, is likely to occur
even under low magnitude of cycling load. There were many reports related to the fatigue failure of DCPs,
while few researches have been done for LCPs. Van Meeteren et al. [5] studied 40 consecutive patients with
subtrochanteric femoral fractures treated with an AO 95 condylar blade plate and found a patient developed
a delayed union, which ultimately resulted in repeated plate fractures due to fatigue. Sivakumar et al. [6] studied a man sustained a fracture of the right femur, and a six-holes tubular compression plate (316L stainless
steel) was implanted. Eight months later the implanted plate fractured at a screw site adjacent to the site of
the original bone fracture. Microscopic examination of the plate fracture surface revealed fatigue striations
and beach marks. Azevedo [7] studied the failure of a titanium reconstruction plate for osteosynthesis, and
found the corrosion on the surface of the implant, which were in contact with body uids. The results indicated that the premature fracture of the plate was caused by a corrosion-fatigue mechanism. Sudhakar [8]
observed the fracture surface of vitallium (CoCrMo alloy) plate, and found the evidences of corrosion-fatigue at the interface between implant plate and screw.
As the treatment of fractures using LCP increased, more clinical studies have been reported and the advantages of this system have been conrmed. Treatment of femoral shaft fracture with LCP is then an alternative,
and has become more popular in treating some indicated cases. However, very few reports regarding fatigue

Fig. 1. (a) Combination hole of LCP; (b) locking head screw [4] and (c) LCP (dimension in mm).

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failure of LCP are available. This study was therefore designed to experimentally evaluate the fatigue failure
an LCP (316L stainless steel) when xed on a diaphyseal-fractured femur (8-mm interfragmentary gap).
2. Material and experimental procedure
2.1. Locking compression plate (LCP)
Fourteen holes broad LCP (18 mm-width and 250 mm-length) and 4 locking head screws (4 mm-diameter
and 45 mm-length) were used for the present study. The LCP and locking head screw are made from 316L
stainless steel. Based on the ASTM recommendation [9], a bar of UNS S31673 or 316L stainless steel was
cut, forged, and machined to obtain the geometry as shown in Fig. 1c. Consequently, it was annealed, electropolished, passivated, and then ultrasonically cleaned. To reveal the microstructure (Fig. 2), the LCP was
sectioned using an electric discharged machine (EDM), polished, etched with 20 g of picric acid and 100 ml
of HCl, and then observed in an scanning electron microscope (SEM). The average grain was approximately
25 lm or ASTM No. 8, i.e. complied with the ASTM recommendation [9]. The hardness of the LCP was
294 HB. The composition of the present LCP was analyzed by an emission spectrometer (Baird: Spectovac
2000 Arc/Spark), as summarized in Table 1. The composition of LCP corresponded to that recommended
by the ASTM standard [10].
2.2. Monotonic loading
In order to avoid the inter-specimen variations of the human femurs in dierent cadavers, the composite
large left femurs (Third-generation femur 3306, Pacic Research Laboratories, Inc., WA) were used for this
study. With similar geometry and mechanical properties to those of young human femur, this composite femur
has been successfully used in many biomechanical researches [1113]. A transverse fracture (8-mm gap) on the
midshaft of composite femur was xed with an LCP using 2 locking screws above and below fracture site, i.e

Fig. 2. SEM micrograph of LCP (316L stainless steel).

Table 1
The composition of LCP
Element

Mn

Si

Cr

Ni

Mo

LCP
316L Stainless
steel [10]

0.018
0.030max

1.84
2.00max

0.025
0.025max

0.009
0.010max

0.305
0.750max

17.82
1719

14.29
1315

2.71

2.253.00 0.100max

Cu

Fe

0.073
0.500max

Bal.
Bal.

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xation in hole number 1, 6 and 9, 14. The technique for xation of the locking screws and the LCPs to the
composite femurs were the standard procedure used in femoral xation of human femur [4].
Loading model (Fig. 3a) used in the present work was similar to the model proposed by Cordey et al. [14],
which took into account with the forces acting through the ilio-tibial tract in the frontal plane and those forces
acting on the femoral condyles in the sagittal plane. A distal femur was supported by a pin and ball bearing in
order to prevent undesirable moment and torque. Epoxy resin was used to stabilize the tested composite femur
to the loading model. Loadings were performed using a servo-hydraulic fatigue machine (Instron 8801) under
25 C temperature and 55% relative humidity. The experimental system is shown in Fig. 3b. To simulate the
maximum load acting on he femur during walking, the femur was compressed from 0 N to 600 N under 60 N/s
loading rate, and held at 600 N for 15 min. Then it was unloaded to 0 N under 60 N/s loading rate. To avoid
complication from residue deformation, the femur was left at zero load for 15 min before the next loading was
started. The 7 strain gages with 0.3-mm gage length (TML, FLA-03-11) were set along the surface (P1P7) of
an LCP (Fig. 1c). During the test, load as well as deformation of composite femur were recorded by the controller of servo-hydraulic fatigue machine, while the strains on the LCP were collected using computerized
data acquisition system (National Instrument: PCI-6013 and LabVIEW 7.0). The loadings were repeated 5
times, and the average values of strain were calculated.
2.3. Cyclic loading
Since, the composite femur was made from short E-glass bers/epoxy resin and solid rigid polyurethane
foam, and it was not designed to withstand the cyclic loading. Therefore, fatigue test of LCP was carried
out using a 4-point bending specimen, i.e. an LCP xed on two cylinders (polyvinyl chloride pipe reinforced
with epoxy resin), as shown in Fig. 4. The maximum strains distributed on the surface of LCP during fatigue

Fig. 3. (a) Monotonic loading model for composite femur and (b) Experimental system for monotonic loading of composite femur.

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Fig. 4. (a) 4-Point bending specimen and (b) Experimental system for cyclic loading of 4-point bending specimen.

test were controlled to match with the strains distributions of LCP-composite femur model under monotonic
loading by adjusting the load positions (L1L4) and the vertical movement of 4-point bending device, as
shown in Fig. 4a. The experimental system is shown in Fig. 4b. In order to maintain contact between specimen
and 4-point bending device, the minimum strains distributed on the surface of LCP were controlled to be 5%
of the maximum strains.
The displacement-controlled fatigue tests (sinusoidal waveform with 3 Hz frequency) were performed by
using a servo-hydraulic fatigue machine at 25 C temperature and 55% relative humidity. The fatigue failure
was dened as a complete fracture of LCP. During fatigue test, the applied load, movement of a 4-point bending device, strain distribution on the surface of LCP, and time were simultaneously recorded 100 times in each
cycle with computer-controlled data acquisition. After fatigue test, the screw torque was checked for of screw
loosing. The fatigue tests in every test condition were performed twice in order to check the repetitiveness.
Fracture surfaces of LCP were observed in an SEM (JEOL: JSM-5410), and the mechanisms of fatigue were
discussed.
3. Results and discussion
3.1. Strain distribution
Under monotonic loading, the variation of strains on an LCP xed on a composite femur from 5 repeated
tests was less than 5%, and the average strains were determined. The tensile strains on LCP surface predominantly distributed between locations P3P5 with the maximum tensile strain of 2450 le (location P4), as
shown in Fig. 5. It should be noted that the distribution of tensile strains obtained in the present work was
only used for the simulation the cyclic strain acting on LCP during walking. The actual location of maximum
strain on LCP was likely to be the surface of combination hole [3,15], and its magnitude could be numerically
determined using the nite element calculation. Under cyclic loading, the peaks of tensile strains on the surface
of LCP were compared with those under monotonic loading, as shown in Fig. 5. Only marginal dierences
(<5%) were observed. It was conrmed that the LCP xed on a 4-point bending device was under the cyclic
strain similar to the strain on LCP during walking.

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Fig. 5. The strains on the surface of LCP.

3.2. Fatigue behavior

Relationships between the maximum compression load applied on 4-point bending device and number of
cycles are shown in Fig. 6. The plot could be divided into three stages; an initial stage (stage I) of rapid
decrease in compression load, a second steady-stage (stage II) in which the rate of decrease in compression
load was fairly constant, and a third stage (stage III) in which the value of compression load decreased rapidly.
It is known that the polymer materials showed cyclic softening behavior. Therefore, the rapid decrease in compression load (stage I) at the beginning of fatigue test was likely to be the cyclic softening of the 4-point bending device, i.e. polyvinyl chloride pipe reinforced with epoxy resin. After a certain number of cycles, the fatigue
crack initiated at the surface of combination hole, and the maximum compression load that maintained stable
maximum movement of 4-point bending device decreased. The initiation of fatigue crack corresponded to the
second steady-stage (stage II) which covered most of the fatigue life of LCP. As fatigue crack propagated
longer, the load bearing area of the LCP decreased, and the stress increased. At this stage, the crack propagated rapidly (stage II), and the complete fracture nally occurred. After fatigue tests, the screw torque was
checked and no screw loosing was detected. The fatigue tests were performed twice, and the repetitiveness of
the results was conrmed.
For the present work, it was assumed that one load cycle per leg takes 2 s, the patient walks 3 h a day, and
the adequate healing of fracture to sustain full load of walking without walking aid occurs within 6 months.
Once the femur is fully healed, the LCP is no longer under severe loading. Based on this assumption, an LCP

Fig. 6. Relationship between the maximum compression load applied on 4-point bending specimen and number of cycles.

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will be cyclically loaded about 106 cycles before healing. According to the present results, the complete fracture
of LCP occurred after 42,000 cycles of loading, i.e. equivalence to about 8 days of walking. Therefore, the
fatigue failure of LCP was possible before the adequate healing of fracture, and the full load of walking should
not be allowed for the patient with the present fracture condition (a transverse fracture with 8-mm interfragmentary gap at the middle of diaphysis).
3.3. Fatigue mechanisms
After fatigue test, the cracks were detected at the middle of LCP, as shown in Fig. 7. Since, the load bearing
area near the compression hole was smaller than that near the locking hole, while the similar deection was
applied on both areas. Therefore, fatigue crack rstly initiated from the surface of compression hole, i.e. crack
A. The fracture surface of area A was observed using optical microscope, and the location of crack initiation
was indicated, as shown in Fig. 8. After some cycles of loading, another fatigue crack (crack B) also initiated
from the surface of locking hole, and then both cracks propagated inside the LCP. The initiation of crack A
and crack B corresponded to the steady reduction of compression load (stage II of Fig. 6).
To reveal the area of fatigue crack initiation, the fracture surface of the crack at the surface of compression
hole (crack A) was observed in an SEM, as shown in Fig. 9. A subsurface inclusion was observed at the area of

Fig. 7. Fatigue cracks at the middle of LCP.

Fig. 8. Fracture surface near the compression hole of LCP.

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Fig. 9. Subsurface inclusion on the fracture surface near the compression hole of LCP.

crack initiation. The composition of the inclusion was analyzed using an energy dispersive spectroscopic technique (EDS, Oxford INCA 300), as shown in Fig. 10. The main element of the inclusion was found to be carbon. According to the ASTM recommendation [16], the surface of the implants should be cleaned to minimize
the iron particles, ceramic media, and other foreign particles. These particles may imbedded into the surface
of the implants during processing operations, e.g. forming, machining, tumbling, bead blasting. Unfortunately, the cleaning was unable to remove some of the foreign particles imbedded below the surface of
LCP (subsurface inclusions). Since, the interface strength between subsurface inclusion matrix was weak
and the stress concentration was severe around the surface of the compression hole, the fatigue crack was
likely to initiate from this subsurface inclusion (Fig. 9). As an evidence of the propagation of fatigue crack,
the striations were observed on the fracture surface (Fig. 11). The striation spacing was long when observed
far from the crack initiation site, and became shorter when observed around the crack initiation site. Based on
the striation spacing at the middle of fracture surface (1 lm) and the thickness of LCP (5 mm), the number of
cycles for the propagation of fatigue crack from the initiation site to the bottom part of LCP was estimated to
be approximately 5000 cycles. This estimation was in accordance with the number of cycles spent during the
stage III of Fig. 6.

Fig. 10. Composition of the subsurface inclusion analyzed by the energy dispersive spectroscopic technique.

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Fig. 11. Fatigue striations on the fracture surface near the compression hole of LCP.

4. Conclusions
The fatigue failure of a locking compression plate (LCP) xed across a transverse fracture (8-mm gap) at
the midshaft of femur was experimentally evaluated. The main ndings are summarized as follows.
1. The complete fracture of LCP occurred after 42,000 cycles of loading, i.e. equivalence to about 8 days of
walking. The fatigue failure of LCP was possible before the adequate healing of fracture, and the full load
of walking should not be allowed for the patient with the present fracture condition.
2. The fatigue crack rstly initiated from a subsurface inclusion embedded under the surface of compression
hole. After some cycles of loading, another fatigue crack also initiated from the surface of locking hole, and
then both cracks propagated inside the LCP.
3. As an evidence of the propagation of fatigue crack, the striations were observed on the fracture surface of
the LCP. The striation spacing was long when observed far from the crack initiation site, and became
shorter when observed around the crack initiation site. Based on the striation spacing, the number of cycles
for the propagation of fatigue crack from the initiation site to the bottom part of LCP was estimated to be
approximately 5000 cycles.

Acknowledgements
The authors would like to acknowledge the supports from the Thailand Research Fund (TRF), the National Research Council of Thailand (NRCT), and the National Metal and Materials Technology Center
(MTEC).
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