Original Research
Complications of Distal Tibiofibular Syndesmotic Screw Stabilization: Analysis of 236 Patients

https://doi.org/10.1053/j.jfas.2013.03.025Get rights and content

Abstract

The objective of the present study was to evaluate our complications of screw stabilization and to formulate recommendations for clinical practice. Using a prospectively collected fracture database, the data from 236 consecutive adult patients were analyzed who had undergone syndesmotic screw stabilization from January 1979 to December 2000 at our level I academic trauma center. We observed 16 complications in 15 patients. The average patient age was 37.5 years. Of the 15 patients, 1 had a Weber B fracture and 14 had a Weber C ankle fracture. These complications included tibiofibular synostosis in 11 patients, screw breakage in 4 patients, and late diastasis in 1 patient. All breakages occurred in Weber C fractures. In particular, the 3.5-mm screws, penetrating both tibial cortices, tended to break. Synostosis was observed in 3% of the Weber B fractures and 5% of the Weber C fractures. Weightbearing in a plaster cast during syndesmotic screw stabilization is a safe postoperative treatment. We suggest that the use of 3.5-mm screws and screws penetrating 2 tibial cortices have a greater risk of breakage. Because of the low complication rate and more difficult treatment of late syndesmotic diastasis, a syndesmotic screw should be placed when in doubt of the indication.

Section snippets

Patients and Methods

Using a comprehensive, prospectively collected, fracture database, created in the framework of the Association for Osteosynthesis documentation, we analyzed the data from adult patients who had undergone syndesmotic screw stabilization from January 1979 to December 2000 at our level I academic trauma center. The patients were treated by experienced orthopedic surgeons and trauma surgeons or by residents under their supervision. All were familiar with the Association for

Results

After reviewing the prospectively collected data in the fracture database, we identified 236 consecutive patients with distal tibiofibular syndesmotic screw stabilization. This group included 152 male and 84 female patients. Of the 236 patients, 36 had a Weber B fracture, 88 a Weber C fracture in the distal third of the fibula, 28 a Weber C fracture in the middle part of the fibula, and 84 a Weber C or Maisonneuve fracture in the proximal third of the fibula. In 109 ankles (2 Weber B

Discussion

Internal fixation of ankle fractures with a syndesmotic screw requires strict awareness of the potential harm that can be inflicted on the tibiotalar and tibiofibular joint and a proper understanding of the biomechanics of the ankle joint structures (24). The question of whether it is harmful to insert a screw from the fibula into the tibia just above the syndesmosis has been asked by several investigators 4, 25, 26.

Although the present study included a large group of patients, the study did

Recommendations for Clinical Practice

  • 1.

    Removal of a synostosis is only advisable in young active patients after maturation of the synostosis

  • 2.

    Protected weightbearing in a plaster cast during the period of syndesmotic screw stabilization is safe postoperatively

  • 3.

    The use of 3.5-mm screws and screws penetrating 2 tibial cortices have a greater risk of breakage

  • 4.

    Removing the proximal part of the broken screw will be sufficient to avoid late pain and functional complaints

  • 5.

    Because of the low complication rate and the much more difficult

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    Conflict of Interest: None reported.

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