Distal tibial fracture post syndesmotic screw removal: an adverse complication

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old woman was admitted with a bimaleollar right ankle fracture. The patient underwent an emergency operation with open reduction and internal fixation. Six weeks after the surgery, the syndesmotic screw was removed without complication. The patient presented 4 weeks after removal of the screw complaining of persistent swelling and tenderness of the right ankle without a history of trauma. Radiographs showed a non-displaced distal tibial fracture around the site at which the syndesmotic screw was inserted. The distal tibial fracture was treated conservatively with a toe-to-knee cast for 6 weeks. In summary, the authors present a rare case of distal tibial fracture. Surgeons should bear this additional complication in mind.