By: 25 October 2011

DP Bell, MK Wong Injury 2006; 37: 891-898

Ankle fractures with syndesmotic disruption are a common injury. Such injuries are usually fixed with a syndesmotic screw, which is placed 2 cm above the tibiotalar joint line. There is no clear guideline whether these screws should be removed or can be left alone indefinitely before allowing full weight bearing status.

The authors performed a retrospective analysis of a series of 30 patients who had a Weber C ankle fracture treated with a syndesmotic screw fixation. In 23 patients the syndesmotic screws were removed prior to weight bearing and in 7 they were left in-situ indefinitely. The average follow up in the two groups was 15 and 16 months respectively. Clinical and radiographic assessment were performed using the Baird and Jackson ankle score.

Statistically there was no significant difference between the functional outcome, ankle scores or range of motion between the two groups. Screw breakages occurred in 2 out of 7 patients in whom the screw was left behind. The difference in incidence of screw breakage between the two groups was significant. Osteolysis was found around the syndesmotic screws in 6 out of 7 patients with retained screws after weight bearing was commenced.

Fixation of Weber C fractures with syndesmotic screws remains a popular technique with good functional outcome. Although the authors had small study groups and the follow ups were not very long, there is the suggestion that a syndesmotic screw can be retained and even if it breaks it does not affect the overall ankle function.