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

Background: Syndesmotic screw breakage is a well-recognized mechanical complication following ankle fracture fixation. Although several studies have investigated patient-related and technical factors associated with screw breakage, the temporal pattern of screw failure and implant survival remains less clearly defined. Therefore, this study aimed to evaluate one-year syndesmotic screw survival using time-to-event analysis and to identify factors associated with screw breakage. Materials and Methods: A total of 132 patients with unstable AO-Weber 44-B/C ankle fractures treated with syndesmotic screw fixation were retrospectively analyzed. Patients were followed for a minimum of 12 months or until screw breakage occurred. Screw survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards regression was performed to identify factors associated with screw breakage. Demographic variables, fracture type, and screw-related parameters were analyzed. Receiver operating characteristic (ROC) analysis was used to assess the discriminative ability of age. Results: Screw breakage occurred in 31 patients (23.5%) during follow-up. Kaplan–Meier analysis demonstrated significantly lower screw survival in Weber C fractures compared with Weber B fractures (log-rank p < 0.001). Cox regression analysis identified younger age (HR: 0.965, 95% CI: 0.937–0.993, p = 0.016) and Weber C fracture type (HR: 1.811, 95% CI: 1.260–2.602, p = 0.001) as independent predictors of screw breakage. ROC analysis showed that age had moderate discriminative ability (AUC: 0.719, 95% CI: 0.612–0.816), with a cut-off value of 35.5 years. Conclusions: Younger age and Weber C fracture type are associated with an increased risk of syndesmotic screw breakage and Weber C fractures also demonstrating reduced screw survival. These findings may assist in patient counseling; however, the clinical implications of screw breakage remain uncertain.