Patterns and Implications of Early Syndesmotic Screw Failure in Rotational Ankle Fractures

Abstract

Background: The purpose of this study was to identify characteristic patterns of syndesmotic screw (SS) failure, and any effects on clinical outcome. Methods: A retrospective study was performed using a consecutive series of patients treated with open reduction and internal fixation with trans-syndesmotic screws for unstable ankle fractures with syndesmotic injury between 2015 and 2017. Patient demographics, fracture characteristics and classification, rates and patterns of trans-syndesmotic screw breakage, and backout were analyzed. Functional outcome was assessed using passive range of motion (ROM) and Maryland Foot Score (MFS). Results: A total of 113 patients (67%) had intact screws and 56 patients (33%) demonstrated either screw breakage or backout. Patients with SS failure were younger ( P = .002) and predominantly male ( P = .045). Fracture classification and energy level of injury were not associated with screw failure. Nine screws (11%) demonstrated backout (2 also broke) and 56 other screws broke. There was no association between the number of screws or cortices of purchase and screw failure. There was a trend toward a higher proportion of screw removal (20%) in this failed SS group compared with the intact SS group (12%) ( P = .25), but with similar ankle ROM and MFS ( P > .07). Conclusion: Syndesmotic screw breakage was common in younger, male patients. Despite similarities in ankle range of motion and clinical outcome scores to patients with intact screws, there was a trend towards more frequent screw removal. This information can be used to counsel patients pre- and postoperatively regarding the potential for screw failure and subsequent implant removal. Level of Evidence: Level III, retrospective case-control study.

Comparison of clinical efficacy of Hybrid fixation, single-screw and single-Tightrope in the treatment of ankle fractures complicated with Distal tibiofibular syndesmosis injury

“…With the development of medicine, there are more and more studies on the use of screws xation to treat the distal tibio bular syndesmosis injury. In a retrospective study conducted by Behery et al [4] ,patients with ankle fractures accompanied by syndesmosis injury were subjected to open reduction and internal xation, along with transsyndesmotic screw xation. Interestingly, the study revealed that screw failure predominantly affected young males, irrespective of the number of screws or the extent of cortical penetration.…”

“…If the issue of neglecting the injury of the tibio bular syndesmosis is disregarded, it can easily lead to chronic instability of the ankle joint or post-traumatic ankle arthritis. Therefore, restoring the anatomical relationship of the distal tibio bular syndesmosis is very important for the recovery of ankle function [2] .In clinical practice, there are many methods to repair distal tibio bular syndesmosis injury, such as one screw, two screws, one Tightrope, two Tightrope, etc [3,4] .According to a meta-analysis by Yoshiharu Shimozono [5] et al, which was based on the best available evidence, screw xation did not currently reach the grade A recommendation for tibio bular syndesmosis xation. Compared with screw xation, Tightrope xation technique can improve functional outcomes of the ankle, reduce the incidence of implant breaking and ankle malreduction, and reach the grade A recommendation for tibio bular syndesmosis xation.…”

Predictors of Hardware Removal in Orthopaedic Trauma Patients Undergoing Syndesmotic Ankle Fixation With Screws

“…Traditionally, rigid screw fixation of the syndesmosis was the mainstay of treatment until biomechanical studies determined that rigid screws have a tendency to over-constrain the joint, which can lead to perception of stiffness or pain at the screw site. 1 , 4 , 7 , 16 , 17 , 29 These factors can lead to patient dissatisfaction following their procedure and lead to requests for hardware removal.…”