Incidence and complications of orthopaedic screw protrusion

This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.

Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.

Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.

This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.