SLR - July 2012 - Jason E. Smith
Reference: Schepers, T. (2011). To retain or remove the syndesmotic screw: a review of literature. Archives of Orthopaedic and Trauma Surgery (2011) 131:879-883
Scientific Literature Review
Reviewed by: Jason E. Smith, DPM
Residency Program: Northern Colorado Podiatric Surgical Residency
Podiatric Relevance:
The decision to remove or retain the syndesmotic screw in ankle fracture care has been a point of discussion. While the stability of the hardware can benefit the patient, the presence of hardware irritation calls for removal. This article reviews the pros and cons of removal which can serve the practicing podiatrist in their decision to remove or retain the hardware.
Methods:
A literature search was conducted electronically over several databases. These included the Cochrane Library, Pubmed Medline, and EMbase. The literature search obtained data from the dates of January 2000 to October 2010.
Results:
Seven studies in total were identified by the search and a majority of the selected studies found no significant difference in outcomes between retained screws and that of removed screws. Instances where removed hardware was loose or broken had similar or better outcomes than those whose hardware was simply removed. However, six studies showed no difference in outcome between retained and removed hardware.
Conclusions:
As the debate of whether to retain or remove syndesmotic hardware continues, this review was an aid in understanding the little difference in outcomes between the two options. It does make the point that painful or irritating hardware should be removed. The author also spurs the question about timelines and when hardware should or can be removed as well as absorbable fixation, but only briefly touches on these points. A more focused study involving the number of cortices involved, number of screws, diameter of screws, cannulated vs. solid, all could provide a better understanding of circumstances requiring removal or retention. It does, however, make a point as to when removal of hardware should be a consideration and points out the need for a randomized controlled trial.