Radiographic and Demographic Factors Associated with Syndesmotic Screw Breakage in Ankle Fractures

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Trauma Care

Background:

• Syndesmotic screw breakage is a known complication in ankle fracture fixation.
• Previous research explored patient and technical factors, but temporal patterns of screw failure and implant survival require further definition.

Purpose of the Study:

• To evaluate one-year syndesmotic screw survival using time-to-event analysis.
• To identify patient and fracture-related factors associated with syndesmotic screw breakage.

Main Methods:

• Retrospective analysis of 132 patients with AO-Weber 44-B/C ankle fractures treated with syndesmotic screws.
• Kaplan-Meier analysis for screw survival and Cox regression for identifying predictors of breakage.
• Receiver operating characteristic (ROC) analysis to assess age's discriminative ability.

Main Results:

• Screw breakage occurred in 23.5% of patients within the follow-up period.
• Significantly lower screw survival was observed in Weber C fractures compared to Weber B fractures (p < 0.001).
• Younger age (p = 0.016) and Weber C fracture type (p = 0.001) were independent predictors of screw breakage.

Conclusions:

• Younger age and Weber C fracture type are significantly associated with an increased risk of syndesmotic screw breakage.
• Weber C fractures exhibit reduced syndesmotic screw survival.
• Findings may aid patient counseling, though the clinical impact of screw breakage needs further investigation.