title: Removal of the syndesmotic screw after the surgical treatment of a fracture of the ankle in adult patients does not affect one-year outcomes: a randomised controlled trial.
abstract: Our aim was to compare the one-year post-operative outcomes following retention or removal of syndesmotic screws in adult patients with a fracture of the ankle that was treated surgically. A total of 51 patients (35 males, 16 females), with a mean age of 33.5 years (16 to 62), undergoing fibular osteosynthesis and syndesmotic screw fixation, were randomly allocated to retention of the syndesmotic screw or removal at three months post-operatively. The two groups were comparable at baseline. One year post-operatively, there was no significant difference in the mean Olerud-Molander ankle score (82.4 retention vs 86.7 removal, p = 0.367), the mean American Orthopedic Foot and Ankle Society ankle-hindfoot score (88.6 vs 90.1, p = 0.688), the mean American Academy of Orthopedic Surgeons foot and ankle score (96.3 vs 94.0, p = 0.250), the mean visual analogue pain score (1.0 vs 0.7, p = 0.237), the mean active dorsiflexion (10.2° vs 13.0°, p = 0.194) and plantar flexion (33.6° vs 31.3°, p = 0.503) of the ankle, or the mean radiological tibiofibular clear space (5.0 mm vs 5.3 mm, p = 0.276) between the two groups. A total of 19 patients (76%) in the retention group had a loose and/or broken screw one year post-operatively. We conclude that removal of a syndesmotic screw produces no significant functional, clinical or radiological benefit in adult patients who are treated surgically for a fracture of the ankle.
authors.affiliation: Middlemore Hospital, Department of Orthopaedic Surgery, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
authors.forename: M J
authors.initials: MJ
authors.lastname: Boyle
authors.affiliation: Middlemore Hospital, Department of Orthopaedic Surgery, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Gao
authors.affiliation: The University of Otago , Department of Medicine, PO Box 4345, Christchurch, New Zealand.
authors.forename: C M A
authors.initials: CM
authors.lastname: Frampton
authors.affiliation: Middlemore Hospital, Department of Orthopaedic Surgery, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
authors.forename: B
authors.initials: B
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome
keywords: Syndesmosis; Ankle fracture; Functional outcomes