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

Schepers, Tim

doi:10.1007/s00402-010-1225-x

Cited by 144 publications

(89 citation statements)

References 46 publications

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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.…”

Section: Discussionmentioning

confidence: 99%

“…Complications recorded were: 1) minor or major wound infection, 2) recurrent syndesmotic diastasis secondary to removal of the syndesmotic screw, and 3) removal of a broken screw. Concerning the latter, a broken screw was not considered a complication in itself, however detection of a broken screw at surgery was considered a complication, as removal would subject patients to potential surgical and anaesthetics risk, without contributing to an additional improvement in motion or outcome 8,23 , making the removal procedure superfluous. Recurrent diastasis was defined as widening of the syndesmosis of more than 2 mm compared with radiographs taken shortly after the first operation, in which the fracture was fixed, or a widening of the medial clear space of more than 2 mm compared with the distance between the tibia plafond (pilon) and talus.…”

Section: Allmentioning

confidence: 99%

“…8,12 In a recent review no favorable outcome was shown when syndesmotic screws were removed on a routine basis compared with screws in place, leaving the issue regarding removal of the syndesmotic screw controversial. 23 In general, implant removal in adults is mainly reserved for failure or complications of the implant or in case of complaints. 3 However, implant removal after ankle fractures has been associated with high wound complication rates of up to 15 percent 22 and secondly resolution of complaints can be expected in only half of the patients.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Allmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complications of Syndesmotic Screw Removal

et al. 2011

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“…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 [43].…”

Section: Rationale Behind Orif Of Ankle Fracturesmentioning

confidence: 99%

Ankle Fractures: A Literature Review of Current Treatment Methods

Singh¹,

Kamal²,

Roulohamin³

et al. 2014

OJO

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Ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the trauma workload. Ankle fractures usually affect young men and older women, however, below the age of 50; ankle fractures are the commonest in men. Two commonly used classification systems for ankle fractures include the danis weber AO classification and the Lauge-Hansen classification. There is biomechanical evidence that posterior non-locking plates are superior in stability than laterally placed plates; however there is little clinical evidence. There are several different methods of ankle fracture fixation, however the goal of treatment remains a stable anatomic reduction of talus in the ankle mortise and correction of the fibula length as a 1 mm lateral shift of the talus in the ankle mortise reduces the contact area by 42%, and displacement (or shortening) of the fibula more than 2 mm will lead to significant increases in joint contact pressures. Further research both biomechanically and clinically needs to be undertaken in order to clarify a preferable choice of fixation.

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“…After surgery, when screw fixation is undertaken, partial weight-bearing is recommended until such time as the screw will be removed [44]. The screw is removed 6-8 weeks after surgery in patients with syndesmosis injury associated with bone fractures or, when only the syndesmosis is injured, after 10-12 weeks [45].…”

Section: Chronic Syndesmosis Injurymentioning

confidence: 99%