Syndesmotic screw fixation in Weber C ankle injuries–should the screw be removed before weight bearing?

Acute Ankle Syndesmosis Injury In Athletes

“…Also the definitive fusion of the syndesmotic area by tibiofibular arthrodesis is a salvage operation and will in general not bring the athlete to his/her previous level of performance. Screw removal before the patient starts weight bearing is recommended to avoid screw breakage [52].To illustrate the operative treatment of syndesmotic injuries, two injured athletes are described.…”

Biomechanical comparison of bionic, screw and Endobutton fixation in the treatment of tibiofibular syndesmosis injuries

“…An ideal implant to stabilize the tibiofibular syndesmosis should allow early mobilization for weightbearing and be strong enough to maintain reduction in the syndesmosis [8], in clinical practice, various different strategies have been used throughout the years, however, there is still no consensus about the optimal method of treatment [9]. The screw fixation is a simple method and provides rigidity of the distal tibiofibular syndesmosis, and it has been considered the standard management [10]; however, this rigid fixation method may be problematic in allowing physiologic motion of the syndesmosis and sometimes screw breakage may occur [11][12][13]. More recently, flexible fixation using the suture button device has been applied, which allows physiologic motion in the tibiofibular joint and, meanwhile, maintains the reduction of the ankle [14][15][16].…”

Syndesmotic Injuries in Athletes

“…Syndesmotic fixation of the tibiofibular joint prevents its normal physiologic movement that occurs during normal weight bearing and ankle range of motion. Needleman et al [101] demonstrated that quadricortical fixation with a 4.5-mm screw decreases tibiotalar external rotation, and may result in fatigue fracture of the screw [102]. Three cortical fixation may decrease the rigidity of fixation and increase physiologic motion, but may also lead to hardware loosening [103].…”

“…Three cortical fixation may decrease the rigidity of fixation and increase physiologic motion, but may also lead to hardware loosening [103]. Other complications associated with the metal screw include inferior tibiofibular synostosis [104] and osteolysis around the implant [102]. To avoid the hardware complications associated with metal screws, bioabsorbable screws have been proposed as an alternative mode of fixation.…”

“…Other complications, such as symptomatic hardware, osteolysis and synostosis, are also possible postoperatively. Bell et al [102] retrospectively reviewed patients with syndesmotic screws, and compared those that had the screw removed versus those in which the screw was maintained. There was no statistical significance between the two groups in ankle scores, range of motion or functional outcome.…”