Aim and objective: There is an increasing body of evidence that syndesmotic screws following stabilization of acute syndesmotic disruption in ankle fractures can be retained if not symptomatic. Some broken screws may remain symptomatic (pain, cortical erosion) and can be difficult to remove. This study aimed to evaluate at what level the syndesmotic screw breaks and how often this occurs at a level that may lead to potential refractory complaints needing further surgical intervention. Materials

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... and methods: All consecutive cases with a surgically treated ankle fracture and subsequent placement of one or more syndesmotic screws were included. The level of syndesmotic screw breakage was divided into six potential different patterns. Intraosseous breakage was considered as a location with possible refractory complaints. The need for subsequent removal of the complete broken syndesmotic screw was recorded. Results: A total of 51 broken syndesmotic screws remained for analysis. The largest amount of screws (22 screws, 43.1%) broke at the level of the lateral tibial cortex. One of the screws broke in-between the fibula and tibia. The need for complete removal of a broken screw (including the medial part) was seen in six screws (11.8% of all broken screws). Conclusion: Albeit broken syndesmotic screws are encountered frequently, the number of locations with possible clinical consequences was low. The need for the complete removal of a broken screw was low. Clinical significance: Retaining the syndesmotic screw should be the new gold standard.