title: High complication rate after syndesmotic screw removal.
abstract: OBJECTIVE
  The aim of this study was to determine the rate of complications after routine syndesmotic screw removal.
  
  
  METHODS
  All patients who underwent syndesmotic screw removal at our hospital between 2007 and 2012 were included in the study. Patient demographics, surgical characteristics, radiographic evaluation and complications were recorded from the patients' charts. Questionnaires were sent by postal mail to all patients, to measure patient satisfaction and pain (VAS scales).
  
  
  RESULTS
  161 patients were included in the trial. A wound infection was found in 8 (5%) patients. 3 were regarded as serious infections requiring hospitalisation and intravenous antibiotics, 2 of those required surgical revisions. 5 patients were treated by oral antibiotics. Staphylococcus aureus was identified as the causing organism in all (6/8) cases with a positive culture. The patients with postoperative infection reported more pain (5.3 vs. 2.3; p=0.02) and were less satisfied (4.7 vs. 7.6; p=0.014) with their ankle compared to those without infection (T-test for independent samples).
  
  
  CONCLUSIONS
  There were 5% wound infections after routine syndesmotic screw removal. Routine antibiotic prophylaxis effective against S. aureus should be administered when removing syndesmotic screws. In our institution we now use one single dose Cefalotin of 2g intravenously 30-60min before screw removal.
authors: Department of Orthopaedic Surgery, Baerum Hospital, Drammen, Norway. Electronic address: merean@vestreviken.no.
authors: Mette Renate
authors: MR
authors: Andersen
authors: Department of Orthopaedic Surgery, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway. Electronic address: frede.frihagen@ous-hf.no.
authors: Frede
authors: F
authors: Frihagen
authors: Department of Orthopaedic Surgery, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway. Electronic address: j.e.madsen@medisin.uio.no.
authors: Jan Erik
authors: JE
authors: Madsen
authors: Department of Orthopaedic Surgery, Baerum Hospital, Drammen, Norway. Electronic address: wender.figved@vestreviken.no.
authors: Wender
authors: W
authors: Figved
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D019072:Antibiotic Prophylaxis; D001863:Bone Screws / Q000382:microbiology*; D002512:Cephalothin / Q000008:administration & dosage; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000382:microbiology* / Q000517:prevention & control; D011300:Preoperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002512:Cephalothin
keywords: Ankle fractures; Complications; Screw removal; Surgical prophylaxis; Surgical site infection; Syndesmotic