Outcome after fixation of ankle

fractures with an injury to the

syndesmosis
 History
Syndesmosis ankle injury is disrupture of the
distal tibiofibula joint
142 patients with 52 inclusion criteria
27 intact
10 broken screws
15 removal screws
They said no difference in clinical outcome of
patients with intact or removed syndesmotic screws
 The syndesmosis will be heal after 8 to 12
weeks.
Advantages removal screw to improve ankle
movement and prevention of potential screw
breakage.
Disadvantage removal screw need to 2nd
surgery and possible losing reduction.

Danis waber
classification
 Patient and Methods
Syndesmosis screw usually was removed at
12 weeks.
Inclusion criteria was limited, patient should
be undergo ORIF with screw for stabil
disrubted syndesmosis within one year
Exclusion criteria age <18 years, chronic injury
(> one month), post infection, post operative
hardware failure, surgery with complication
 Table 1 patient demographies and fracture pattern
screw
intact broken removed p-value
number 27 10 15
Mean age (range) 50 (22 to 35 (21 to 50 (21 to 69) 0.081
72) 63)

Male (%) 44 80 53 0.174

Fracture pattern 9B, 18C 3B, 7C 3B, 12C 0.716
(Weber class)
Mean time to full 10.2 (8 to 10.5 (8 to 9.7 (8 to 13) 0.217
weight-bearing (weeks) 26) 18)

Insurance status
Private 15 8 10 0.097
Other 12 2 4
 Table 2 Clinical outcome based on the integrity of the
syndesmosis scre

Screw
retalned
intact broken Screw removed p-value
Number 27 10 15
Visual analogue scale 2.31 0.96 (2.31) 0.74(0.97) 0.217
Mean (SD) (2.76)

AOFAS*
Mean (SD) 83.07 92.40 (12.69) 85.80 (11.33) 0.0466
(13.59)
Radiograph
 Conclusion
In this retrospective study of 52 unmatched
patients who underwent screw fixation of the
syndesmosis for a Weber B or C fracture of the
ankle, there was no statistical difference between
the clinical outcomes of patients who had the
screw removed and those who retained an intact
screw
they recommended removal of the syndesmosis
screw before the patient returned to full activity
Our data do not support the routine removal of
the intact or broken syndesmosis screw