title: Safety of ankle trans-syndesmotic fixation.
abstract: BACKGROUND
  Ankle syndesmosis fixation is often employed with the utilization of many variable methods and implants. Complications secondary to trans-syndesmotic fixation have been described, yet the proximity of a single trans-syndesmotic screw to the perforating branch of the peroneal artery (PBPA) has not.
  
  
  METHODS
  Sixteen cadaveric legs received a single trans-syndesmotic screw using standard AO technique. The PBPA was identified and the following distances were measured using photographic images and morphometric software: the tip of lateral malleolus to the PBPA, the tibial plafond to the PBPA, tip of lateral malleolus to the screw, and the PBPA to the screw. Average distances were calculated and statistically compared.
  
  
  RESULTS
  The location of the trans-syndesmotic screw inserted 2 cm proximal to the tibial plafond was on average less than 1.3 cm distal to the PBPA. In six out of the 16 specimens, the screw was less than 1 cm from the PBPA. In one specimen, the screw came within 0.22 cm of the PBPA.
  
  
  CONCLUSIONS
  The placement of trans-syndesmotic fixation places the PBPA at risk. In order to avoid injury to the PBPA with trans-syndesmotic fixation, fixation should be avoided 2.3 to 4.1 cm proximal to the tibial plafond or 4.5 to 6.2 cm proximal to the tip of the lateral malleolus in females and 2.8 to 5.9 cm proximal to the tibial plafond or 5.1 to 7.2 cm proximal to the tip of the lateral malleolus in males.
authors.affiliation: St. Vincent Mercy Medical Center, Osteopathic Medical Education, Toledo, OH 43608-2691, USA. njf48@yahoo.com
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Fanter
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Inouye
authors.forename: Angus M
authors.initials: AM
authors.lastname: McBryde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects*; D002102:Cadaver; D019544:Equipment Failure Analysis; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012737:Sex Factors; D013977:Tibia / Q000098:blood supply / Q000473:pathology / Q000601:surgery*