Abstract
Screw fixation of the injured syndesmosis restores stability, but may reduce ankle motion. We wished to determine whether functional and radiographic results are improved by removal of syndesmosis screws. In addition, we studied whether large fragment screws have an advantage compared to small fragment screws. We hypothesised that retained intact syndesmosis screws are detrimental to ankle function.
One hundred and seven adults with ankle fractures requiring syndesmosis screw fixation between 2001 and 2005 were retrospectively studied. Indications for syndesmosis fixation were a positive intraoperative external rotation stress test or inadequate lateral column buttress. Weight bearing was encouraged six weeks postoperatively. Syndesmosis screws were only removed for tenderness, prominence or ankle dorsiflexion < 0.05.
The LEM score for patients with intact screws was 70 ± 26 compared with 85 ± 20 for broken, loosened or removed screws (p=0.05). The OM score for patients with intact screws was 48 ± 36 compared with 63 ± 27 for broken, loosened or removed screws (p=0.12). There was no difference in outcome comparing broken, loosened, and removed screws. The tibiofibular clear space for intact screws was 3.3 ± 1.3 compared with 4.1 ± 1.7 for removed, broken or loosened screws (p=0.02). There was no difference in outcome comparing large and small fragment screws.
Patients with broken, loosened or removed syndesmosis screws have better functional outcome compared to intact screws. The syndesmosis allows fibular rotation, shortening and translation during gait; the presence of an intact syndesmosis screw may restrict this motion. There was no disadvantage to leaving broken or loosened screws in-situ.
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