title: Complications of distal tibiofibular syndesmotic screw stabilization: analysis of 236 patients.
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.
authors: Orthopaedic Surgeon, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. Bekerom@gmail.com
authors: Michel P J
authors: MP
authors: van den Bekerom
authors: Peter
authors: P
authors: Kloen
authors: Jan S K
authors: JS
authors: Luitse
authors: Ernst L F B
authors: EL
authors: Raaymakers
mesh_terms: D000328:Adult; D064386:Ankle Fractures; D016512:Ankle Injuries / Q000150:complications / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome