title: To retain or remove the syndesmotic screw: a review of literature.
abstract: BACKGROUND
  Syndesmotic 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.
  
  
  METHODS
  A comprehensive literature search was conducted in the electronic databases of the Cochrane Library, Pubmed Medline and EMbase from January 2000 to October 2010.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  There 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.
authors.affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre, Room H-822k, PO Box 2040, CA 3000 Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
authors.forename: T
authors.initials: T
authors.lastname: Schepers
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001863:Bone Screws; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D007593:Joint Instability / Q000517:prevention & control*; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D018570:Risk Assessment; D016474:Weight-Bearing