ABSTRACT
Background Screw fixation continues to be a commonly used treatment for syndesmotic disruption; however, screw breakage remains a complication post-fixation. Despite this complication, investigation on the variability of surgical placement in conjunction with syndesmotic screw characteristics affecting breakage has not been fully elucidated. The purpose of this study is to compare patients with syndesmotic screw breakage versus those with intact screws based on surgically controlled variables. Methods A total of 176 patients and 260 syndesmotic screws were included in the study, 88 patients each with and without broken syndesmotic screws. A retrospective analysis of patients who underwent syndesmotic screw fixation was performed. Patients with syndesmotic screw breakage were compared to those with intact screws. Screw width and length, the number of screws used, fracture type, and the number of cortices for fixation were all collected. Further analysis included radiographic measurement of syndesmotic screw angle and height of placement above the tibial plafond. Results Decreased screw width, increased number of screws used, and younger age were all associated with increased rates of screw breakage (p < .001, p = .019, p = 0.020). No statistical difference was appreciated between groups based on screw length, number of cortices used, or angle relative to the tibial plafond (p = .2432, p = .4699, p = .9233). Conclusion Higher placement of syndesmotic screws above the tibiotalar joint, specifically greater than 20 mm above the tibial plafond, increases the screw breakage rate. Decreased screw width, increasing numbers of screws used, and younger age were all also associated with increased rates of screw breakage. No difference was appreciated based on the screw angle relative to the tibial plafond.
ABSTRACT
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.
ABSTRACT
Poikiloderma with neutropenia (PN), is a rare autosomal recessive condition with many associated complications and manifestations. Here we present a patient with confirmed PN who is of one-quarter Chucktaw or Cherokee heritage with no known descent from the Navajo tribe. The patient's condition was complicated by chronic bilateral lower limb cellulitis and associated osteomyelitis which was unresponsive to extensive antibiotic regimens. Subsequent treatment with hyperbaric oxygen therapy (HBOT) was successful. To date, no author has reported on the treatment of recurrent cellulitis using HBOT in this patient population. Based on our experience, HBOT should be considered in patients with PN.
