SLR - April 2010 - Shannon R. Schnell
Reference:
Boraiah S., Helfet D., Lorich D., et al. (2010). Functional outcomes after syndesmotic screw fixation and removal. Journal of Orthopaedic Trauma, 24, 12-16.
Scientific Literature Review
Reviewed by: Shannon R. Schnell, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
The purpose of this study is to determine the objective and subjective outcomes for removal of syndesmotic screws after primary repair of syndesmotic injuries.
Methods:
A 14-month prospective study of 25 patients with tibiofibular syndesmosis disruption requiring transyndesmotic screw stabilization was performed between July 2007 and January 2008. Per protocol, verification of a syndesmotic disruption was obtained via magnetic resonance imaging. All injuries were fixated with 2 locked syndesmotic screws in a 3 hole 1/3 tubular plate. The fixation was removed 4 months after insertion. Patient follow-up was performed at 2, 6, 12, 16, 18 and 28 weeks and 1 year post-operatively. Standard radiographic evaluation and range of motion measurements were completed at each visit. Subjective data was obtained utilizing validated Foot and Ankle Outcome Score (FAOS) and Olerud and Molander Ankle Score (OMAS) outcome questionnaires which were obtained pre- and postoperatively, and at each follow-up visit.
Results:
Prior to syndesmotic plate and screw fixation removal, the average ankle joint range of motion was 10 degrees dorsiflexion and 35 degrees plantarflexion. After fixation removal, dorsiflexion was 20 degrees and 45 degrees of plantarflexion. No radiographic loss of reduction was noted at the final follow-up visit. An immediate statistical improvement in both the FAOS and OMAS was noted after syndesmotic screw removal.
Conclusion:
Previous studies and the literature provide no recommendations regarding the removal of syndesmotic screws. Though limited, this study showed a significant subjective improvement by all participants after fixation removal. Ankle joint range of motion also improved greatly after the removal of the syndesmotic screws. The positive outcome of this study indicates the need for a larger multi-center study. Limitations in this study included a nonrandomized study cohort without a control group, a small sample size, and no long-term functional results.