Factors associated with adverse events after distal tibiofibular syndesmosis fixation

Factors associated with adverse outcomes following surgery for syndesmotic instability with associated closed fibula fracture are incompletely understood. The purpose of this study was to determine the pathoetiology and incidence of adverse events after stabilization of syndesmotic instability. In addition, we aimed to identify any patient or surgeon related factors that might be associated with unanticipated outcomes.

Between January 2000 and May 2015, a total of 849 adult patients who were surgically treated with either screw or suture button fixation for syndesmotic instability with associated fibula fracture without open wound were identified and retrospectively evaluated. Multivariable logistic regression analyses were used to determine factors associated with any postoperative complication or unplanned reoperation.

Within one year after surgery, 10.7% (91 patients) suffered an infectious complication and 22.0% (187 patients) underwent unplanned reoperation. Factors associated with infectious complications were increased duration of hospital admission (OR: 1.08, p = .014), use of an external fixator device before ORIF (OR: 5.19 p < .001), peripheral vascular disease (OR: 4.33, p = .008), and osteoporosis (OR: 2.71, p = .022). For unplanned hardware removal specifically, patients' BMI below 30 was an associated risk factor. (OR: 1.50, p = .010).

Certain patient groups have an increased risk of adverse events following the use of current surgical fixation methods for stabilizing the syndesmosis. Patients undergoing surgery for syndesmotic instability with associated fibula fracture without open wound should be counseled that up to 1 in 10 suffer an infectious complication and that 1 in 5 require unplanned hardware removal.