The effect of syndesmotic screw removal or retention on functional results of patients with malleolar fractures
Emrah Kovalak, Fırat Seyfettinoğlu, Mert Tüzüner, Yalım Ateş
Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi 2. Ortopedi ve Travmatoloji Kliniği
Keywords: Ankle injuries/classification/surgery; bone screws; fracture fixation, internal/methods.
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.