Abstract : Fixation failure is a common issue in orthopedic practice that carries negative impact specially on patients, in addition to burden on both doctor and health system. Our aim the most common pattern of failure, and the most common possible factor for fixation failure. An observational was conducted at the orthopedic surgery department in Imam Al Hussein medical city in Karbala from April 2018 to December 2019. Seventeen patients with 20 fixed fractures met the criteria for entry and were eligible to be included in the study, where recent significant trauma near the fixation area, pathological fractures, spine and per prosthetic fractures were excluded.17 patients with 20 fixation failures were reviewed and 11 of them were male and 6 were female. 70% of fixation failure occurred in lower limb while 30% in upper limb, plates constituted 75% (15 cases) meanwhile 10% found in dynamic hip screws and cannulated hip screws and 5% (1 case) was external fixation. Inadequate surgical technique was the most common cause of fixation failure (80%), others like obesity (35.2%), poor patient compliance (17.6%), and infection (10%) were contributed to fixation failure in lesser extent. Among technical issue; improper implant was 65%, meanwhile inadequate reduction was found in 60%, and improper Implant application was found in 85% of cases. Among plate-screw group (15 cases); the commonest pattern fixation failure was; screws cutout (53.3%) followed by broken plate (46.6%) and screws pullout (46.6%) and we relied on AO principles in evaluating these aspects of fracture management. Improper implant choice, incorrectly performed fixation techniques, deficient post-operative care and underestimation of fracture morphology all were possible causes.