The effect of syndesmotic screw removal or retention on functional results of patients with malleolar fractures

Abstract

Objectives: We evaluated the effect of syndesmotic screw removal on functional results of patients treated with surgery for malleolar fractures in comparison with those whose syndesmotic screws remained postoperatively.
Patients and methods: The study included 27 patients (16 males, 11 females; mean age 44.5 years; range 15 to 61 years) who were operated on for malleolar fractures and had a syndesmotic screw applied. According to the Weber classification, the fractures were type A in 10 patients (37%), type B in 12 patients (44.4%), and type C in five patients (18.5%). The syndesmotic screw was removed in 16 patients after a mean of 7.6 weeks (range 6 to 9 weeks). Functional results were assessed with the use of the Weber protocol. The mean follow-up was 28 months (range 25 to 42 months) and 30 months (range 24 to 40 months) in patients whose screws were removed and remained, respectively.
Results: Of 16 patients whose screws were removed, the results were excellent in four (25%), good in seven (43.8%), and poor in five patients (31.3%). In those who did not have screw removal, excellent, good, and poor results were detected in three (27.3%), five (45.5%), and three patients, respectively. No significant differences were found between the two groups with respect to healing, pain scores, and the presence of arthrosis (p>0.05).
Conclusion: Our results suggest that, following tricortical elastic screw fixation, full weight-bearing can be allowed after complete syndesmotic healing without the need for screw removal.