Technical tip: Removal of a broken tri-cortical syndesmotic screw using a “perfect circle” technique

Riedel, Matthew D.; Briceño, Jorge; Miller, Christopher P.; Kwon, John Y.

doi:10.1016/j.injury.2018.02.022

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…There is additional evidence to suggest that patients with broken or loosened syndesmotic screws may have better functional outcomes than those with intact screws. 19 This study provides the first clinical data on a novel alternative to traditional screws and suture-button devices for fixation of syndesmotic injuries that may fulfill both of the above criteria: retention and breakage. We evaluated short-term radiographic outcomes and complication rates, and our preliminary results indicate that the R3lease screw is a safe and effective option for syndesmotic fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Breakage within the fibula or tibia can lead to painful bony erosion given physiological translation and rotation that occurs at the incisura fibularis. 19 Extraction can be technically difficult and lead to unwanted complications. 20 A novel syndesmotic screw designed with a controlled break point between the tibia and fibula as well as design features that allow for easier extraction of both fragments if needed was recently released (R3lease Tissue Stabilization System, Paragon 28, Denver, Colorado; Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Stenquist

Velasco

Cronin

et al. 2019

Foot & Ankle Specialist

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Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Stenquist

Velasco

Cronin

et al. 2019

Foot & Ankle Specialist

Self Cite

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show abstract

“…Screw removal after breakage is challenging and not without risks. [15][16][17][18] As such, a means of identifying screws at risk for intraosseous breakage may be of significant value to surgeons. We constructed a logistic regression model evaluating several clinical and radiographic parameters for their ability to influence breakage site.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, subsequent screw removal can be technically challenging, in particular with broken tricortical screws. 15,16 Because no previous investigation has critically examined and differentiated outcomes based on the location of breakage, we performed the current investigation. We observed a relatively high rate of intraosseous breakage in patients with retained screws and a significant association between intraosseous breakage and eventual implant removal for pain in this subset of patients.…”

Section: Discussionmentioning

confidence: 99%

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Ibrahim

Velasco

et al. 2020

Foot & Ankle Specialist

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Background. The majority of retained syndesmotic screws will either loosen or break once the patient resumes weight-bearing. While evidence is limited, anecdotal experience suggests that intraosseous screw breakage may be problematic for some patients due to painful bony erosion. This study seeks to identify the incidence of intraosseous screw breakage, variables that may predict intraosseous screw breakage, and whether intraosseous screw breakage is associated with higher rates of implant removal secondary to pain. Methods. Five hundred thirty-one patients undergoing syndesmotic stabilization were screened, of which 43 patients (with 58 screws) experiencing postoperative screw breakage met inclusion criteria. Patient charts were retrospectively reviewed for demographic data, comorbidities, time to screw breakage, location of screw breakage, and implant removal. Several radiographic parameters were evaluated for their potential to influence the site of screw breakage. Results. Intraosseous screw breakage occurred in 32 patients (74.4%). Screw breakage occurred exclusively in the tibiofibular clear space in the remaining 11 instances (25.6%). Intraosseous screw breakage was significantly associated with eventual implant removal after breakage (P = .034). Screws placed further from the tibiotalar joint were at less risk for intraosseous breakage (odds ratio 0.818, P = .002). Screws placed at a threshold height of 20 mm or greater were more likely to break in the clear space (odds ratio 12.1, P = .002). Conclusion. Syndesmotic screw breakage may be more problematic than previously described. Intraosseous breakage was associated with higher rates of implant removal secondary to pain in this study. Placement of screws 20 mm or higher from the tibiotalar joint may decrease risk of intraosseous breakage. Levels of Evidence: Level III: Retrospective study

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“…However, as the patient begins weight-bearing, most syndesmotic screws tend to loosen or break, where intraosseous breakage is associated with higher rates of implant removal compared to that in the clear space [2]. Although previous studies have reported techniques to remove a broken syndesmotic screw [3][4][5], there exists limitations concerning the removal of a tricortical-fixed non-cannulated screw. Furthermore, as a case of distal tibial fracture following syndesmotic screw removal has been previously reported [6], caution is required.…”

Section: Introductionmentioning

confidence: 99%

Removal of broken syndesmotic screw with minimal bone defects in Korea: a case report

Kyung¹,

Park²

2023

J Trauma Inj

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Ankle fractures with syndesmotic injuries often require fixation, where metal screw fixation is a popular method. However, as the patient begins weight-bearing, most syndesmotic screws tend to loosen or break, and removal of such screws has been challenging for the surgeons, as the available techniques require predrilling or trephination and are associated with risks of bone damage. This study presents a case with technical tip for the removal of broken tricortical-fixed non-cannulated syndesmotic screws. It implements the generation of a small cortical window in the medial distal tibia and the use of pliers to engage the screw tip and remove through the medial side. The technique presented in the current study overcomes these limitations and facilitates minimal bone damage and reduced exposure to radiation.

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Technical tip: Removal of a broken tri-cortical syndesmotic screw using a “perfect circle” technique

Cited by 8 publications

References 17 publications

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

Removal of broken syndesmotic screw with minimal bone defects in Korea: a case report

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