Syndesmotic Screw Research Articles

Ankle Fractures Treated with Locked Fibular Intramedullary Nailing: Description and Outcomes of a Minimally Invasive Open Technique

OBJECTIVES: To describe and report outcomes of a minimally invasive open intramedullary (IM) fibular nailing technique for fixation of ankle fractures. METHODS: Design: Case Series Setting: Urban Level 1 trauma center Patient Selection Criteria: Adult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing via a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024. Outcome Measures and Comparisons: Quality of reduction, complications, and patient-reported outcomes (PRO). RESULTS: A total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17-97) years, and mean BMI was 30.6 ± 7.4 kg/m2. 93(62%) patients were female, and 78 (52%) patients were Caucasian. 72 (48%) patients were obese, 40 (27.7%) patients were current/former smokers, 39 (26%) patients were diabetic, and 23 (15.3%) patients had open fractures. 37 (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65(43.3%) had trimalleolar fractures. 123 (82%) patients had 2 syndesmotic screws placed, 26 (17.3%) had 1 screw, and 1 (0.7%) had none. Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan’s criteria. 113 patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3-22) months). 110 patients (97.3%) went on to successful clinical and radiographic union following the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. 3 patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). 9 (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants). Mean ankle range of motion at final follow-up visit was 12.9° (0-40) of dorsiflexion, 39.6° (10-70) of plantarflexion, 23.5° (5-40) of inversion, and 18.2° (5-50) of eversion. Mean PROs at final follow-up visit were: Global Physical Health: 42.4 (23.5-67.6), Global Mental Health: 47.5 (21-67.6), Physical Function: 37.5 (14.7-57.8), Pain: 54.9 (22-72) and Mobility: 36.9 (16-65.3). CONCLUSIONS: Minimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient reported outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparative Study between Syndesmotic Rupture Treated by Suture-Button and Syndesmosis Screw

Comparative Study between Syndesmotic Rupture Treated by Suture-Button and Syndesmosis Screw

How has acute syndesmotic injury management evolved over the last decade? Results from a national survey

The management of acute distal tibiofibular syndesmotic injuries has evolved over time and therefore, the aim of this study was to evaluate the use of different methods and the changes regarding management of distal tibiofibular syndesmotic injury among Dutch trauma- and orthopedic surgeons.A digital survey based on a previous survey conducted in 2012 was sent to (orthopedic) trauma surgeons from all different hospitals in the Netherlands.Sixty out of the 68 invited hospitals completed at least one survey (88.2 %). For Weber B or low Weber C fractures, there was a preference for the use of a single syndesmotic screw (SS)(73.6 %), while two screws were mainly used in Maisonneuve fractures (89.3 %). Furthermore, there was a clear preference for 3.5-mm screws, engaging three cortices, 2 to 4-cm above the tibiotalar joint. There is a significant decrease in routine removal of SSs (23.2 % compared to 87.0 % in 2012, p < 0.01). The percentage of hospitals in this survey that used the suture button (SB) was relatively low: 8.3 % for low fibular fractures and 5.0 % in high fibular fractures.In conclusion, the most striking difference compared to 2012 is the large decline in routine removal of the SS, which is in line with current literature. The SS is mainly implanted engaging three cortices, placed 2-4 cm above the tibiotalar joint and 3.5 mm in size and for the treatment of Maisonneuve fractures, two screws are preferred over a single SS. Level of evidenceLevel III

Is There Any Purpose in Routine Syndesmotic Screw Removal? Systematic Literature Review.

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. Results: Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula-tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. Conclusions: The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated.

Post-treatment Functional Outcomes of Distal Tibiofibular Syndesmosis Injuries With Varying Duration and Method of Stabilization

The purpose of this study was to assess whether the type and duration of screw fixation affects ankle joint functional scores and patient activity levels. We evaluated 55 patients who had undergone surgical treatment for ankle fracture with concomitant distal tibiofibular syndesmosis injury. The follow-up period ranged from 2 years to 4 years and 2 months (mean 36 months). Depending on the time of screw removal, patients were divided into 2 groups (the 8–15-week group-19 patients, and the 16–22-week group-36 patients). There were 17 patients with tricortical and 38 patients with quadricortical syndesmosis fixation. The following parameters were assessed: range of motion, rates of complications, level of pain in visual analogue scale (VAS), and function. In the quadricortical fixation group the range of plantar flexion p = .04 and adduction p = .043 were significantly lower in the operated than in the nonoperated limb. In the patients who had their syndesmotic screws removed after 16–22 weeks, the range of plantar flexion in the operated limb was significantly lower than that in the nonoperated limb. We observed no differences between the evaluated groups in terms of ankle joint mobility, VAS pain levels, functional outcomes, or complication rates. All the analyzed subgroups showed poorer ranges of some types of motion in the ankle and worse functional scale and VAS pain scores after treatment in comparison with those before the injury. We suggest removing the syndesmotic screws after 8–15 weeks, due to the possibility of earlier rehabilitation, faster return to work and physical activity and less burden on the health care system. Tricortical or quadricortical syndesmosis fixation is at the surgeon's discretion.

Surgical Outcomes of Syndesmotic Fixation of Ankle Fractures Using Syndesmotic Screws Versus Suture Button Devices.

Ankle fractures associated with disruption of the syndesmotic complex could potentially have poorer outcomes if missed or malreduced at the time of surgery.Favourable results have been reported for the suture button (SB) technique and may provide advantages over standard screw fixation of the syndesmosis, although this remains the gold standard method in many units. To compare the outcomes of syndesmotic screws (SS) with SB fixation of the syndesmosis during ankle fracture fixation at a high-volume orthopaedic department of a Scotland trauma unit. A cross-sectional, retrospective study looking at ankle fracture fixations was undertaken at the Clyde Trauma Unit, Paisley. Relevant information was obtained from electronic patient records for 457 ankle fracture patients between August 2019 and February 2022 and followed up for six months. The digital patient archive system (PACS) was used for evaluating radiographs. Patients were divided into two groups depending on whether they had an SS or SB fixation of their syndesmosis. We focused on the surgical and radiological outcomes following syndesmotic fixation as no functional scores following surgery were conducted on the patients. Out of the entire study group, 26.3% (120/457 patients) required syndesmotic fixation. Within the syndesmotic fixation group, 70.8% (85/120 patients) underwent SS fixation, and 29.2% (35/120 patients) had an SB fixation. Both groups were statistically well-matched. Additionally, 21.1% (18/85) of SS fixation went on to have a second surgical procedure (four fixation failures, five planned removals, five for pain/stiffness, two infections, and two metalwork breakage/migration), whereas 8.6% (3/35) of the SB fixation group had a secondary procedure - two for fixation failures and one for infection. We reported a higher incidence of associated syndesmotic injury in our series of 457 ankle fractures than previously described. There were significantly fewer sequelae in the SB group compared to the SS fixation group (P = 0.0464). Although we did not observe a statistically significant difference in the rate of reoperation (P = 0.1184), this is likely due to the small numbers in the SB group.Our study suggests that SB fixation may be associated with a lower rate of reoperation for post-op complications such as metalwork failure, pain, and stiffness (21.1% SS vs 8.6% SB). Regardless of the fixation method used, accurate reduction of the ankle mortice and syndesmosis is a key step to a successful surgical outcome.

Syndesmotic fixation in Weber B ankle fractures: A systematic review.

Weber Type B fractures often arise from external rotation with the foot supinated or pronated. Altered tibiofibular joint kinematics in Weber B fractures are responsible for syndesmotic damage seen in Weber B fractures. Weber B fractures are managed using open reduction and internal fixation if displaced. The syndesmosis is injured in up to 40% of cases resulting in an unstable injury with a syndesmotic diastasis. This systematic review aimed to evaluate the current literature on syndesmotic fixation in Weber B fractures, assess the outcomes and complications of syndesmotic fixation and assess the necessity of syndesmotic fixation in Weber B fractures. A search was carried out on the EMBASE, PubMed and CINAHL databases and eight studies assessing the outcomes of syndesmotic fixations versus no syndesmotic fixation with 292 Weber B ankle fractures were included in this systematic review. Results showed significant heterogeneity so a narrative review was conducted. Results of these studies showed that functional, radiological, and quality-of-life outcomes and incidences of post-traumatic osteoarthritis in patients with syndesmotic screws were similar to those of patients not managed with syndesmotic screws. Only one favoured syndesmotic fixation in all cases of diastasis. As such, syndesmotic fixation with screws may not be necessary in the management of Weber B fractures. Screws are also associated with breakage, loosening, local irritation and infections. Suture button devices and antiglide fixation techniques appear to be valid alternatives to syndesmotic screws. It was found that there was no need for routine hardware removal unless the hardware was causing significant side effects for the patient.

Dislocations deteriorate postoperative functional outcomes in supination-external rotation ankle fractures

PurposeTo assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures. MethodsA retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18–65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American orthopedic foot and ankle society score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. ResultsDuring the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, preoperative complications with diabetes, smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American orthopedic foot and ankle society score revealed no significant difference between dislocation and no-dislocation patients. ConclusionDislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.

Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation.

Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation. It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months. Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications. The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up. Level II.

Risk factors associated with breakage of tibio-fibular syndesmotic screws.

This retrospective study aimed to investigate the factors associated with the breakage of tibio-fibular syndesmotic screws (SS). 69 patients with unstable AO-Weber Type 44-B ankle fractures who underwent three cortex SS (3.5mm ø) fixation were included. Patients were followed for at least one year (mean, 18.3 ± 7.6months). At the final follow-up, patients with broken (Group I) and intact (Group II) SS were compared regarding age, gender, height, weight, body mass index, fracture type, SS length, location, and orientation. Multivariate logistic regression was used to identify the independent risk factors associated with SS breakage. The sensitivity, specificity, cut-off value, and area under the ROC curve were analyzed. A stepwise backward logistic regression analysis revealed that age was the only independent predictor for SS breakage (OR = 0.938, 95% CI = 0.904-0.973, R2 = 0.270). ROC curve analysis demonstrated that patients younger than 36years were associated with seven times increased risk of SS breakage [Odds ratio (95% CI), 7.042 (2.251-22.031)]. Age under 36years was the only significant risk factor for SS breakage. The higher incidence of breakage of the syndesmotic screw can be informed to patients younger than 36.

Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis.

The present meta-analysis evaluated current level I clinical trials which compared the use of a suture button (SB) versus syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. It was hypothesised that SB might achieve better PROMs along with a lower rate of complications. This study was conducted according to the 2020 PRISMA statement. In August 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed. All the randomised controlled trials (RCTs) which compared SB versus SS fixation for syndesmosis injuries of the ankle were accessed. Data concerning the American Orthopaedic Foot & Ankle Society (AOFAS), and Olerud-Molander score (OMS) were collected at baseline and at last follow-up. Data on implant failure, implant removal, and joint malreduction were also retrieved. Data from seven RCTs (490 patients) were collected. 33% (161 of 490) were women. The mean length of the follow-up was 30.8 ± 27.4months. The mean age of the patients was 41.1 ± 4.1years. Between the two groups (SB and SS), comparability was found in the mean age, and men:women ratio. The SS group evidenced lower OMS (P = 0.0006) and lower AOFAS (P = 0.03). The SS group evidenced a greater rate of implant failure (P = 0.0003), implant removal (P = 0.0005), and malreduction (P = 0.04). Suture button fixation might perform better than the syndesmotic screw fixation in syndesmotic injuries of the ankle.

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography.

The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5cm, from 0.5 to 5cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5mm exhibited the least potential for peroneal artery injury. Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5cm proximal to the ankle joint using a 3.5mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

Clinical results of fixation of syndesmosis rupture using simultaneously syndesmotic screw and suture button in case of high fibular fracture (case clinical series)

Clinical results of fixation of syndesmosis rupture using simultaneously syndesmotic screw and suture button in case of high fibular fracture (case clinical series)

Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

Introduction The optimal surgical approach for malleolar fractures and distal tibiofibular syndesmotic (DTFS) disruption remains controversial. There is no uniform treatment protocol for this type of injury.The objective was to review modern surgical treatments of the pathology and determine the optimal option.Material and methods Articles of French, English, Uzbek, Kazakh, German, Danish, Japanese and Chinese authors were retrospectively reviewed. An internet search of MedLine; PubMed; Scopus; Web of Science, CINAHL, the Cochrane Central Register of Controlled Trials databases was performed.Results Comparative studies of dynamic fixation and static fixation of the DTFS showed advantages of the dynamic methods enabling precise, anatomical syndesmotic fixation and faster healing. Dynamic fixation methods would require no implant removal, while syndesmotic screw woul be taken off to reduce compression in the ankle joint and minimize a risk of malreduction facilitating mobility of the ankle joint. Dynamic methods are associated with greater stability and less complication rate. However, static methods have the advantages of being more accessible and less expensive, which can be an important factor choosing a treatment method. Static methods are a wide application and can be used in a wide range of clinical cases. Long-term results show no statistically significant differences between dynamic fixation and static fixation.Discussion Literature review indicates the dynamic method with suture-button, a combined method and titanium cable isotonic annular fixation system as the preferred technique for surgical stabilization of distal syndesmosis associated with ankle fractures with a lower risk of postoperative complications and the possibility of short-term rehabilitation.Conclusion The choice between dynamic and static methods of distal syndesmosis fixation depends on many factors, including the complexity of the injury, the availability and cost of implants and the experience of the surgeon.

Ankle fractures with Chaput fragment: A new classification system with insights into morphology and relation to surgical treatment

BackgroundThe Chaput fragment, a bony avulsion of the anterolateral margin of the distal tibia, is a less commonly discussed fracture pattern in ankle injuries. Its significance in ankle fractures and the optimal fixation technique remains unclear due to limited literature. This study aims to describe the morphology of ankle fractures with Chaput fragment and introduce a new classification system. Materials and methodsWe retrospectively analyzed 33 patients with ankle fractures with associated Chaput fragment treated at our institute over a 3-year period. Data on patient demographics, fracture classification, surgical approach, and fixation method were collected, and a novel classification system for Chaput fragments was proposed. ResultsFour distinct morphological types of Chaput fragment were identified (types 1–4), and three newer variants of trimalleolar fractures were identified (anterior, lateral, and medial variants). Type 1 refers to a small avulsion fragment attached to the anterior-inferior tibiofibular ligament; Type 2 is an anterolateral oblique type; Type 3 refers to an anterolateral fragment with extension into the medial malleolus and Type 4 is a comminuted Chaput fragment. Type 1 Chaput fragment was the most prevalent (60.6%), followed by Type 2 (24.3%), Type 4 (9.1%), and Type 3 (6.1%). The fixation methods ranged from screw fixation, plate fixation, and suture fixation to combinations of these techniques or even indirect stabilization with syndesmotic screws. ConclusionOur new classification system based on morphology includes all possible variants of Chaput fracture. This preliminary data needs to be corroborated by more studies and validated by a larger number of observers

The Radiological Anatomy of the Distal Tibiofibular Joint: A Retrospective Computed Tomography Study.

Introduction Distal tibiofibular joint (DTFJ) injuries are commonly encountered in patients with ankle fractures. Achieving optimal fixation is mandatory, but it requires a thorough understanding of the local anatomical relationships. For this reason, we performed a retrospective CT study in healthy ankles to radiologically describe the normal anatomy of the DTFJ and the anatomical relationship of the fibula within the ankle joint. Materials and methods For this study, we retrospectively examined 60 CT scans of healthy, non-injured ankles in a plantigrade position. Patients with prior ankle surgery or systemic diseases with ankle involvement were excluded because we needed to describe the normal anatomy of the joint. The radiological evaluation included the position of the fibula in the fibular notch and the rotational relationship of the fibula with the talus and the medial malleolus. Results Our study included 60 healthy ankles. Thirty-three were right ankles, and 27 were left. The cohort included 36 females and 24 males with a mean age of 48.3 years old. We found that the fibular notch was retroverted on the transverse plane, with the tibiofibular engagement being 0.11 mm (SD=1.57 mm, SE=0.2 mm), at 1 cm proximally to the tibial plafond. Additionally, we observed that the fibula was internally rotated against the lateral talar facet, while the medial and lateral malleolus facets were externally rotated in between. Moreover, we found a strong positive correlation between the incisura retroversion and fibular engagement at 1 cm above the tibial plafond line (Pearson correlation=0.273, p=0.03). Conclusion Our study highlights the importance of gaining a comprehensive understanding of the inherent anatomy of the DTFJ to achieve reduction goals in ankle fractures. According to our results, in ankle fracture treatment, surgeons should aim for anatomical fracture and syndesmotic fixation, with the fibula in internal rotation against the lateral talar facet. Additionally, as normal tibiofibular engagement is borderline, we do not suggest that over-tightening the syndesmotic screws is essential. This study's findings can aid surgeons in reducing the malreduction rates in patients with ankle fractures.

Syndesmotic injury with ankle fracture: A systematic review of screw vs dynamic fixation.

Cortical screw fixation across the tibiofibular joint is the mainstay of treatment for syndesmotic injury. Dynamic fixation devices have been developed offering similar advantages to screw fixation in terms of reduction and stability of the syndesmosis. Dynamic fixation may also facilitate a more physiological movement between the tibiofibular joint and thus incur less morbidity. Patient's rehabilitation potential is enhanced and reduces the need for hardware removal.Our systematic review aims to analyse the relevant current literature and compare screw fixation to dynamic fixation in the treatment of syndesmotic injury associated with acute ankle fractures.A literature search was performed on Pubmed and Ovid Medline to find scientific papers relating to syndesmotic fixation in acute ankle fractures. Papers were screened and included dependent on predetermined criteria. Risk of bias was assessed after screening full papers by two independent reviewers. Tables and analysis were made using Microsoft excel.A total of 8 papers with 673 patients were included. We found no functional difference between screw fixation or dynamic fixation groups at final follow-up. Three papers showed statistically significant lower rates of reoperation in the dynamic fixation group.Dynamic fixation may offer lower post operative complications and reoperation rates. Therefore, dynamic fixation may be a beneficial alternative treatment compared to traditionally used syndesmotic screws.

Does the Time taken to Remove the Syndesmosis Screw Influence the Onset of Tibiotalar Osteoarthritis

Introduction: Syndesmosis lesions are common in ankle trauma. They can be treated with screws (rigid fixation) or endobuttons (elastic fixation). When rigid fixation is chosen, the problem arises as to how long it should be removed, since according to some authors, prolonged retention of the screw can impair ankle biomechanics and lead to osteoarthritis in the long term. In our study, for various reasons, this screw was either removed at different times or remained in place. The aim of this study was to assess the impact of the time taken to remove the syndesmosis screw on the outcome of the ankle. Materials and method: We carried out a cross-sectional, analytical study with a retrospective and a prospective phase. Patients presenting with ankle trauma with syndesmostic lesion, without risk factors for osteoarthritis were included. Parameters such as age, sex, radiological analysis postoperatively and at the last follow-up, time to removal of the syndesmosis screw and AOFAS score for functional assessment. Data were analyzed using CS Pro7.5 software. Results: Eighty-one patients participated in the study. Mean age was 47.21 ±16.88. The majority were men, with a sex ratio of 1.38. All patients underwent surgical treatment with screw fixation of the syndesmosis. According to the time of screw removal, 02 were removed before 8 weeks, 20 between 8-12 weeks and 49 after 12 weeks. Assessment using the AOFAS score showed excellent results in 17 patients (21%), good results in 28 patients (35%), fair results in 27 patients (33%) and poor results in 9 patients (11%). The analysis between the time of screw removal and the onset of osteoarthritis showed signs of osteoarthritis beyond 12 weeks, with a rate of 44.4%. Conclusion: A syndesmosis screw left in place for more than 12 weeks increases the risk of osteoarthritis.

Comparison of Clinical Results between Deltoid Ligament Augmentation and Syndesmosis Screw Fixation in Bimalleolar Equivalent Fracture

Comparison of Clinical Results between Deltoid Ligament Augmentation and Syndesmosis Screw Fixation in Bimalleolar Equivalent Fracture

Functional outcome of routine versus on-demand removal of the syndesmotic screw.

The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.