Complications of distal tibiofibular syndesmotic screw stabilization: Analysis of 236 patients

Michel P.J. Van den Bekerom*, Peter Kloen, Jan S.K. Luitse, Ernst L.F.B. Raaymakers

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


The objective of the present study was to evaluate our complications of screw stabilization and to formulate recommendations for clinical practice. Using a prospectively collected fracture database, the data from 236 consecutive adult patients were analyzed who had undergone syndesmotic screw stabilization from January 1979 to December 2000 at our level I academic trauma center. We observed 16 complications in 15 patients. The average patient age was 37.5 years. Of the 15 patients, 1 had a Weber B fracture and 14 had a Weber C ankle fracture. These complications included tibiofibular synostosis in 11 patients, screw breakage in 4 patients, and late diastasis in 1 patient. All breakages occurred in Weber C fractures. In particular, the 3.5-mm screws, penetrating both tibial cortices, tended to break. Synostosis was observed in 3% of the Weber B fractures and 5% of the Weber C fractures. Weightbearing in a plaster cast during syndesmotic screw stabilization is a safe postoperative treatment. We suggest that the use of 3.5-mm screws and screws penetrating 2 tibial cortices have a greater risk of breakage. Because of the low complication rate and more difficult treatment of late syndesmotic diastasis, a syndesmotic screw should be placed when in doubt of the indication.

Original languageEnglish
Pages (from-to)456-459
Number of pages4
JournalJournal of Foot and Ankle Surgery
Issue number4
Publication statusPublished - 1 Jul 2013
Externally publishedYes


  • Ankle
  • Complication
  • Injury
  • Instability
  • Screw
  • Syndesmosis


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