Background: Unstable ankle injuries with
associated disruption of the distal-fibular syndesmosis are typically
managed by adjunctive placement of temporary syndesmotic positioning
screws. The widespread notion that positioning screws must be removed by
default after healing of the syndesmosis remains a topic of debate
which lacks scientific support. The present study was designed to test
the hypothesis that syndesmotic positioning screws are safely retained
per protocol in asymptomatic patients.
Patients and Methods:
A retrospective analysis of an institutional prospective database was
performed during a 5-year time-window at an academic level 1 trauma
centre in the United States. All ankle fractures requiring surgical
fixation were included in the analysis. The primary outcome parameter
consisted of the rate of elective hardware removal for syndesmotic
positioning screws within 6 months after surgical fixation.
Results:
A total of 496 consecutive patients with 496 isolated ankle fractures
managed by surgical fixation were included in this study. Of these, 140
injuries were managed by placement of syndesmotic positioning screws.
Within 6 months follow-up, 17.1 % of all syndesmotic screws were found
to be radiographically broken, and 13.6 % of syndesmotic screws revealed
radiographic signs of loosening. Only 2 patients (1.4 %) required the
elective removal of symptomatic positioning screws within 6 months of
surgical fracture fixation. Conclusion: Despite
the high rate of radiographic complications related to breaking or
loosening of syndesmotic screws in almost one third of all cases, more
than 98 % of all patients remain asymptomatic and do not require a
scheduled hardware removal. The routine removal of syndesmotic
positioning screws does not appear to be justified from a patient safety
perspective.
Literature;
: Is the Standard Retention of Syndesmotic
Positioning Screws after Ankle Fracture Fixation Safe and Feasible? A
Retrospective Cohort Study in 140 Consecutive Patients at a North
American Trauma Centre.
Orthop Unfall 2014; 152(6): 554-557
