title: Weber C ankle fractures: a retrospective audit of screw number, size, complications, and retrieval rates.
abstract: Tibiofibular transfixation of Weber C injuries using a diastasis screw is the current method of fixation. However, controversy remains regarding the screw size and number, number of cortices engaged, and the interval to screw removal. The present study reviewed the current practice in the Wellington Region. A retrospective audit of patients with documented Weber C injuries in the Capital & Coast District Health Board from June 2012 to December 2013 was performed. The clinical medical records and radiographs were reviewed, and the patient demographics, surgeon details, screw number, size, cortices engaged, screw removal period, and documented complications were recorded. A total of 36 operations were documented, of which 27 (75%) cases also required fibula plating. Of the 36 cases, 25 (69.44%) used a single diastasis screw, 33 (91.67%) used 4.5-mm screws, and 18 (50%) engaged 3 cortices. Surgical practice did not vary with the experience level. Of the 36 patients, 29 (80.56%) underwent routine screw removal at a median of 20 (25th to 75th quartile range 16 to 22) weeks. Also, 9 (25%) cases of screw fracture occurred, with a median documented interval to fracture of 18 (25th to 75th quartile range 15 to 20) weeks. The surgical management of Weber C injuries is consistent with current practice. The routine removal of diastasis screws by 20 weeks postoperatively was not different from the documented interval of screw removal when screw fractures had occurred. The timing of screw removal needs to be weighed against the fracture risk, patient symptoms, and the risk of secondary procedure complications.
authors.affiliation: Orthopaedic House Surgeon, Department of Orthopaedics, Capital and Coast District Health Board, Wellington, New Zealand; Honorary Clinical Lecturer in Orthopaedics, Otago University, Wellington, New Zealand. Electronic address: logan.walker@ccdhb.org.nz.
authors.forename: Logan
authors.initials: L
authors.lastname: Walker
authors.affiliation: Orthopaedic Consultant Surgeon, Department of Orthopaedics, Capital and Coast District Health Board, Wellington, New Zealand; Clinical Lecturer in Orthopaedics, Otago University, Wellington, New Zealand.
authors.forename: Nigel
authors.initials: N
authors.lastname: Willis
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects*; D054869:Clinical Audit; D020878:Device Removal; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D009520:New Zealand; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cortices; diastasis screw; screw breakage; screw removal; syndesmosis