Syndesmosis Screw Breakage: An Analysis of Current Literature

CATEGORY: Ankle; Trauma INTRODUCTION/PURPOSE: Syndesmosis screw fracture is a common occurrence post syndesmosis screw fixation. The purpose of this study is to analyze all studies that include syndesmosis injury fixed with syndesmosis screws based on patient, screw, and surgical/rehabilitation characteristics. An emphasis will be placed on patients who suffered syndesmosis screw fracture following fixation. To date, no review has examined patient, screw, and surgical/rehabilitation characteristics with an emphasis on screw fractures in this patient population. METHODS: Of the 482 articles assessed for eligibility, a total 52 articles were selected for full-text review. Following further inclusion criteria requirement 21 articles were included in the study. Each study was analyzed based on patient, screw, and surgical/rehabilitation characteristics. Patient demographics and comorbidities of gender, age, BMI, smoking, alcohol abuse, diabetes, soft tissue conditions were included. Screw characteristics that were included were screw material, number of screws, screw width, number of cortices, and number of patients with screw fracture (screw fracture rate). Surgical/rehabilitation characteristics included ankle position, screw placement above tibial plafond, screw angle, routine removal, rehabilitation process, and time to full weight bearing. RESULTS: A total of 1,196 patients, 761 men and 440 females, were included in the analysis. The average number of patients in each study was 59.80±39.41(12-161). Comprehensive screw, surgical, and rehabilitation + outcome data can be seen in Table 1, 2, and 3, respectively. Nine studies reported on ankle position during surgery; dorsiflexion was the most common. Fourteen reported on placement of the screw above the tibial plafond, with 2 cm being the most common. Five reported on screw angle. 141 patients had a fractured screw(s). The average fracture rate was 11.41%. Five of the 21 studies reported BMI. Three studies stratified data comparing broken screw versus intact screw patients. Five reported on diabetes, one on alcohol abuse, and one study reported on comorbidities. CONCLUSION: In conclusion, analysis of syndesmosis screw fracture patients versus those with no fracture was difficult due to lack of differentiation in almost all the studies. Notably, syndesmosis screw fracture studies under report patient characteristics, specifically BMI. Comorbidities, especially BMI, are potential cofounding variables within this patient population and could contribute to screw failure. Future studies should include both BMI and comorbidities when analyzing patients whose syndesmosis fixation resulted in screw breakage.