BMI and Comorbidities in Patients with Syndesmosis Screw Breakage

Abstract

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis screw fixation remains a common standard of care in patients with syndesmosis injuries. Post-operative screw breakage is a common occurrence in these patients. The purpose of this is study is to compare BMI, comorbidities, and characteristics of patients who had a syndesmosis injury repaired with screw fixation resulting in screw failure. Numerous studies (21) have examined patients with syndesmosis screw fracture, focusing primarily on screw characteristics such as width, length, and screw material. Of those studies, only six considered BMI, while only one of the six differentiated BMI between patients with a broken screw and those without. Only three of the studies collected patient comorbidity data. Methods: This study examined all tibia procedures at a level 1 trauma center from 2008 to 2019. Only patients treated with syndesmosis screw fixation that resulted in a screw fracture were included for further analysis. In total, 14 patients satisfied this criterion. A comprehensive analysis of each patients BMI, comorbidities, and characteristics was then performed. Age, gender, height, weight, BMI, smoking status, diabetes, hypertension, alcohol abuse, and soft tissue conditions were all analyzed. Further examination of conditions with potential to impact bone quality such as osteoporosis, osteoarthritis, and rheumatoid arthritis were also included. Results: Eight females and 6 males with an average age of 42.43±13.90(20-43) were included in the analysis. The average number of comorbidities was 2.93±(0-6). BMI average was 38.92±(22.05-56.34) indicating Grade II obesity for the entire patient cohort. Six patients had a BMI > 40 or Grade III (morbidly obese) while only two patients had a satisfactory BMI < 25. All patients in the syndesmosis fracture group had more than one comorbidity apart from a single patient (case 3). Six patients had at least 2 comorbidities, 3 patients had 3, 2 patients had 2, and 2 patients had 6. Eight (57%) of 14 had post-operative complications including: Symptomatic hardware + removal (6), revision surgery (4), and compartment syndrome (1). Five patients retained their broken screw without complication. Conclusion: Patients with syndesmosis screw breakage are a highly comorbid population. Patients in this study, on average, had a significantly elevated BMI potentially predisposing them to screw failure. In conclusion, future analysis of syndesmosis injuries should include BMI and comorbidities. Future studies should pay special attention to BMI as potential confounding variable when attempting to determine reasons for syndesmosis screw breakage.