Introduction/purpose: Concerns have been raised about screw breakage within the tibia or fibula, referred to as intraosseous breakage. The purpose of this investigation is to analyze the technical aspects of syndesmotic screw placement in multiple anatomic breakage locations.
Materials: A retrospective analysis of over 1056 patients who underwent syndesmosis fixation was completed. Demographics, screw length, width, number, height above the tibial plafond, angle, breakage location, and breakage location on the screw were collected and analyzed.
Results: Intraosseous (IO) screw breakage (91 screws, 68 patients) was more common than clear space (CS) breakage (28 screws, 18 patients) (P = < 0.001). Within the IO group, screw breakage within the tibia (60 screws, 52 patients) was more common compared to fibula breakage (29 screws, 24 patients) (P = < 0.001).Increased BMI and the use of multiple screws were associated with IO breakage (P = .007) and CS breakage (P = .012), respectively. Increased screw angle and age were associated with fibular IO breakage (P = .021, P = .036) when compared to other IO breakage locations. Screw angle and placement showed no significant differences between compared groups (P = .629, P = .570).
Conclusion: Syndesmosis screw breakage, overall, occurred more commonly in an IO location. When compared to IO breakage, the use of multiple syndesmosis screws is most associated with CS breakage. Increased BMI is associated with increased IO breakage when compared to CS breakage. Patients with IO screw breakage within the fibula had increased age and placed at a higher angle when compared to other IO breakage locations. No other factors related to screw placement, including the height of placement, were found to be significantly associated with location of screw breakage.
Keywords: Breakage; Clear space; Intraosseous; Screw; Syndesmosis.
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