title: Ankle syndesmotic fixation using two screws: risk of injury to the perforating branch of the peroneal artery.
abstract: Trans-syndesmotic screws are commonly used to repair syndesmosis ruptures and stabilize the ankle joint. Just as with any surgery, the neurovascular structures can be compromised, causing complications. We evaluated the position of the perforating branch of the peroneal artery to define the risk of arterial compromise during placement of 2 trans-syndesmotic screws. In 37 cadaveric specimens, 2 trans-syndesmotic screws were inserted 2 and 4 cm proximal to the ankle joint. The distances between the perforating branch of the peroneal artery and the screws and the other anatomic landmarks were measured. Significant differences were calculated between the male and female limbs, and regression analysis was used to determine the significant associations between the tibial length and screw location. The perforating branch of the peroneal artery passed through the interosseous membrane 3.42 ± 0.6 cm proximal to the tibial plafond. The artery was located up to 4 mm from the superior and inferior screws 51.4% and 10.8% of the time, respectively. A greater percentage of male specimens displayed close proximity between the artery and the superior screw, and the distance of the artery from the distal fibula was statistically significant compared with the distance in the female specimens. Regression analysis revealed that the greater the tibial length, the closer the superior screw was to the artery, with a negative correlation discovered for the inferior screw. We concluded that superior screw placement increased the risk of injuring the perforating branch of the peroneal artery injury, and the likelihood of injuring the artery with the inferior screw increased as the length of the tibia decreased.
authors.affiliation: Podiatrist, HealthCare Partners Affiliate Medical Group, Huntington Beach, CA; Assistant Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA. Electronic address: kpenera@healthcarepartners.com.
authors.forename: Keith
authors.initials: K
authors.lastname: Penera
authors.affiliation: Richmond Square Medical Centre, Calgary, Alberta, Canada.
authors.forename: Karim
authors.initials: K
authors.lastname: Manji
authors.affiliation: Assistant Professor, Department of Anatomy, Western University of Health Sciences College of Osteopathic Medicine of the Pacific and College of Podiatric Medicine, Pomona, CA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Wedel
authors.affiliation: Assistant Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA.
authors.forename: David
authors.initials: D
authors.lastname: Shofler
authors.affiliation: Associate Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, and Medical Director, Foot and Ankle Center, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Labovitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016909:Tibial Arteries / Q000293:injuries*; D055815:Young Adult
keywords: ankle fracture; complication; screw fixation; syndesmotic ligament; tibia; tibiofibular transfixation