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Background Cranioplasty is a common procedure following decompressive craniectomy for reasons including traumatic brain injury or stroke in order to repair a skull defect. Cranioplasty failure is an infrequent occurrence, but in the case of synthetic implants, it is usually caused by infection and incorrect sizing. However, trauma-induced displacement, breakage, and deformities of cranioplasty implants are less common.Observations We present a unique case of a cranioplasty failure due to displacement of a polyetheretherketone (PEEK) implant secondary to catastrophic breakage of the titanium fixation plates (figure1). The patient received the initial cranioplasty following a subarachnoid hemorrhage and subsequent decompressive hemicraniectomy. The cause of displacement is unknown but is suspected to be trauma. A subsequent review of the literature contextualizes common reasons for failure among synthetic implants and suggests that fracture of synthetic implants or their fixation plates is extremely rare.Lessons The displacement of a PEEK cranioplasty implant due to breakage of titanium fixation plates is a rare albeit possible complication of this neurosurgical procedure. Lifestyle modifications are paramount to reduce trauma risk and resultant cranioplasty failure. The addition of miniplates may also reduce implant displacement risk. Finally, since rates of failure differ by material, careful consideration of the type of material used for the implant should be incorporated into neurosurgical planning.Disclosures G. Branscom: None. E. Ren: None. M. Lemonick: None. B. Ezzat: None. Z. Rifi: None. S. Majidi: None.Abstract E-308 Figure 1