Movement at the ankle joint after driving a screw across the inferior tibiofibular joint

Hooper, Judith

doi:10.1016/0020-1383(83)90052-9

Cited by 13 publications

(6 citation statements)

References 4 publications

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“…6,7 Despite a lack of consensus knowledge on which practice best manages these injuries, arguments supporting removal of syndesmotic screws are based on an understanding that rigid trans-syndesmotic fixation contributes to abnormal ankle movement. [8][9][10] Fundamentally, syndesmotic screw fixation immobilizes the ligamentous disruption between the distal tibia and fibula to increase the likelihood of syndesmotic ligament healing. Kinematically speaking, rigid syndesmotic fixation inhibits physiologic tibiofibular movement and also hampers dorsiflexion.…”

Section: Levels Of Evidence: Level Iv: Systematic Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review

Walley

Hofmann

Velasco

et al. 2016

Foot & Ankle Specialist

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Section: Levels Of Evidence: Level Iv: Systematic Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review

Walley

Hofmann

Velasco

et al. 2016

Foot & Ankle Specialist

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“…Proponents of this policy state that tibiofibular movement is affected by leaving the screw in place and dorsiflexion is hampered [33, 34]. This is accompanied by the possibility of breakage of the screw when left in place [35].…”

Section: Introductionmentioning

confidence: 99%

“…Prominent reference books [36, 37] in the field of fracture care still advocate removal of the syndesmotic screw prior to weight-bearing at 6–8 weeks, which to date, influence current practice [38, 39]. However, this statement has been disputed since the late 1950s and early 1960s [33, 40–44]. In 1985, De Souza et al [45] showed that in a group of 30 patients with a syndesmotic screw, of which 12 were left in place, no difference in outcome, pain and motion between retained and removed screws could be detected after an average of 36 months.…”

Section: Introductionmentioning

confidence: 99%

To retain or remove the syndesmotic screw: a review of literature

Schepers

2010

Arch Orthop Trauma Surg

144

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IntroductionSyndesmotic positioning screws are frequently placed in unstable ankle fractures. Many facets of adequate placement techniques have been the subject of various studies. Whether or not the syndesmosis screw should be removed prior to weight-bearing is still debated. In this study, the recent literature is reviewed concerning the need for removal of the syndesmotic screw.Materials and methodsA comprehensive literature search was conducted in the electronic databases of the Cochrane Library, Pubmed Medline and EMbase from January 2000 to October 2010.ResultsA total of seven studies were identified in the literature. Most studies found no difference in outcome between retained or removed screws. Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws. Removal of the syndesmotic screws, when deemed necessary, is usually not performed before 8–12 weeks.ConclusionThere is paucity in randomized controlled trials on the absolute need for removal of the syndesmotic screw. However, current literature suggests that it might be reserved for intact screws that cause hardware irritation or reduced range of motion after 4–6 months.

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“…Hampering of dorsiexion and affection of the tibiobular movement by retaining the screw are the ndings brought out by another group of 13,14 researchers . Breakage of the screw may also happen by leaving it in 14 16 place In a cadaveric study, Needleman et al showed that a 4.5 mm screw xed across four cortices reduced anterior and posterior talar translation and tibiotalar exorotation.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes Following Syndesmotic Screw Fixation- A Comparison of Screw Removal Versus Retention.

Thampi

Babu

George

et al. 2020

IJAR

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BACKGROUND: - The incidence of distal tibiofibular syndesmotic injury in ankle fractures is about 13%. The integrity of syndesmosis is a critical factor which stabilizes ankle mortise during weight-bearing besides load transmission. The primary purpose of the study was to assess the functional outcome in patients with Weber B and C fractures and to decide whether the syndesmotic screws are to be removed or not before weight-bearing. MATERIALS AND METHODS: - This was a prospective observational study involving patients (>18 years of age) who had undergone open reduction and internal fixation of an ankle fracture belonging to Weber B or C classification who had screw stabilization of a disrupted syndesmosis. The study period was three years commencing from August 2014. They were divided into two groups based on the syndesmotic screw retention or removal before weight-bearing. The patients were then regularly followed up with American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score and Visual Analogue Score-Foot and Ankle (VAS-FA) score were used to assess the functional outcome. Clinical and radiographic evaluations were done with each follow-up at 4,6,9,12 months. RESULTS: - We identified 32 fractures in 32 patients. Treatment undertaken was open reduction and internal fixation for the malleolli and syndesmotic screw fixation in all patients, and syndesmotic screws were removed in 17 and retained in 15. None of the patients were managed conservatively. We lost a patient to long-term follow-up. The AOFAS score was seen to be progressively increasing (92.3 – 96.75) and higher in the removed group as compared to retained. The VAS-FA score was also seen to be increasing besides being higher in the removed group (160.17 to 187). None of the patients failed the operative stabilization. Also, none of the patients had long-term complications like non-union, mal-union or screw back out excepting one patient who had persistent pain in the retained group. CONCLUSION: It is safe and better to remove the syndesmotic screw prior to weight bearing, when compared to retaining them insitu. Level of evidence IV-prognostic

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Movement at the ankle joint after driving a screw across the inferior tibiofibular joint

Cited by 13 publications

References 4 publications

Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review

Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review

To retain or remove the syndesmotic screw: a review of literature

Functional Outcomes Following Syndesmotic Screw Fixation- A Comparison of Screw Removal Versus Retention.

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