Functional and Radiographic Results of Patients with Syndesmotic Screw Fixation: Implications for Screw Removal

Manjoo, Ajay; Sanders, David; Tieszer, Christina; MacLeod, Mark

doi:10.1097/bot.0b013e3181a9f7a5

Cited by 187 publications

(162 citation statements)

References 30 publications

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“…Ankle function with an intact syndesmotic screw was reported to be inferior to that with screw removal [13,18]. In our study, Fig.…”

Section: Discussionmentioning

confidence: 47%

“…Ankle function between patients with or without syndesmotic screw breakage was not statistically different (p=0.343). Ankle function in patients with a broken or removed syndesmotic screw is reported to be better than in those with an intact syndesmotic screw [13,18]. In biomechanical terms, the syndesmosis is immobilised by an intact syndesmotic screw and leads to inferior ankle function.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

Hsu

Lee

et al. 2010

International Orthopaedics (SICOT)

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“…Ankle function with an intact syndesmotic screw was reported to be inferior to that with screw removal [13,18]. In our study, Fig.…”

Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

Hsu

Lee

et al. 2010

International Orthopaedics (SICOT)

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“…Removal of the syndesmotic screw might be advisable only in case of complaints related to the implant 23 2. In case removal is considered, it should be performed after a minimum of eight weeks 10,13 3. Antibiotic prophylaxis should be considered upon removal 22 4.…”

Section: Discussionmentioning

confidence: 99%

Complications of Syndesmotic Screw Removal

et al. 2011

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Background: Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures. Methods: This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery. Results: A total of 76 patients were included. A wound infection occurred in 9.2% (N=7) of which 2.6% (N=2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N=5) of patients, and in 6.6% (N=5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann- Whitney U-test; p= 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage ( p = 0.038). Conclusion: A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal. Level of Evidence: IV, Retrospective Case Study

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“…In addition, Miller et al showed that postoperative ankle function improved slightly after the removal of screws for fixation of a distal tibiofibular syndesmosis 24 . In addition, clinical data have shown that screw position in 22%-52% of patients who undergo distal tibiofibular syndesmosis fixation is not accurate, which may lead to decreased range of motion in the ankle [25][26][27] . In 2015, a study by Schottel et al revealed that deltoid ligament repair may be an alternative approach for screw fixation of the distal tibiofibular syndesmosis 28 .…”

Section: Management Of the Distal Tibiofibular Syndesmosismentioning

confidence: 99%

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

Wang

Zhang

Yin

et al. 2017

Orthopaedic Surgery

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Objective: To investigate the effect of internal fixation on postoperative ankle function in patients with supinationexternal rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury.Methods: Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function.Results: A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The sutureanchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups. Conclusion:Medial malleolus fracture and deltoid ligament injury are two different presentations of supinationexternal rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.

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Functional and Radiographic Results of Patients with Syndesmotic Screw Fixation: Implications for Screw Removal

Cited by 187 publications

References 30 publications

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

Complications of Syndesmotic Screw Removal

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

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