Technical tip: Removal of a broken tri-cortical syndesmotic screw using a "perfect circle" technique

Matthew D Riedel; Jorge Briceno; Christopher P Miller; John Y Kwon

doi:10.1016/j.injury.2018.02.022

Technical tip: Removal of a broken tri-cortical syndesmotic screw using a "perfect circle" technique

Injury. 2018 Apr;49(4):877-880. doi: 10.1016/j.injury.2018.02.022. Epub 2018 Mar 2.

Authors

Matthew D Riedel¹, Jorge Briceno², Christopher P Miller², John Y Kwon²

Affiliations

¹ Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA. Electronic address: mdriedel@partners.org.
² Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

PMID: 29496318
DOI: 10.1016/j.injury.2018.02.022

Abstract

While broken or loose syndesmotic screws are typically of no clinical consequence, occasionally breakage can result in pain, metal fretting, or bony erosion. Despite quad-cortical syndesmotic screws being relatively easy to remove due to the prominent screw tip penetrating the medial tibial cortex, removal of a broken tri-cortical screw can be technically challenging. The purpose of this manuscript is to describe a safe technique for removing the buried, broken tri-cortical screw fragment via a minimally invasive medial tibial approach by verifying the screw location using intra-operative fluoroscopy.

Keywords: Ankle fracture; Hardware removal; Screw removal; Surgical technique; Syndesmosis; Technique tip.

Publication types

Case Reports

MeSH terms

Adult
Ankle Injuries / surgery*
Bone Screws / adverse effects*
Device Removal / instrumentation
Device Removal / methods*
Female
Fracture Fixation, Internal / adverse effects*
Fracture Healing / physiology
Guidelines as Topic
Humans
Radiography*
Range of Motion, Articular
Treatment Outcome