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To retain or remove the syndesmotic screw: a review of literature.

Schepers T - Arch Orthop Trauma Surg (2010)

Bottom Line: A total of seven studies were identified in the literature.Most studies found no difference in outcome between retained or removed screws.Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre, Room H-822k, PO Box 2040, CA 3000 Rotterdam, The Netherlands. t.schepers@erasmusmc.nl

ABSTRACT

Introduction: Syndesmotic positioning screws are frequently placed in unstable ankle fractures. Many facets of adequate placement techniques have been the subject of various studies. Whether or not the syndesmosis screw should be removed prior to weight-bearing is still debated. In this study, the recent literature is reviewed concerning the need for removal of the syndesmotic screw.

Materials and methods: A comprehensive literature search was conducted in the electronic databases of the Cochrane Library, Pubmed Medline and EMbase from January 2000 to October 2010.

Results: A total of seven studies were identified in the literature. Most studies found no difference in outcome between retained or removed screws. Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws. Removal of the syndesmotic screws, when deemed necessary, is usually not performed before 8-12 weeks.

Conclusion: There is paucity in randomized controlled trials on the absolute need for removal of the syndesmotic screw. However, current literature suggests that it might be reserved for intact screws that cause hardware irritation or reduced range of motion after 4-6 months.

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Related in: MedlinePlus

Flowchart showing literature search 
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Related In: Results  -  Collection


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Fig1: Flowchart showing literature search 

Mentions: Figure 1 shows the strategy of the literature search. A total of seven studies mentioning both the outcome of removed or retained syndesmotic screw were identified in the literature (Table 1). Six studies found no difference in outcome between retained or removed screws [17, 28, 32, 46–48]. In the study by Hamid et al.[47], patients with a broken screw had the highest outcome scores. Manjoo et al. [49] showed a less favorable outcome in retained screws that were intact, but screws that were broken or showed loosening had similar outcome as removed screws. In these seven studies, the time of removal was 3 months on average [17, 28, 32, 46–49]. Manjoo et al. [49] recommended screw removal only when still intact after 6 months.Fig. 1


To retain or remove the syndesmotic screw: a review of literature.

Schepers T - Arch Orthop Trauma Surg (2010)

Flowchart showing literature search 
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3117259&req=5

Fig1: Flowchart showing literature search 
Mentions: Figure 1 shows the strategy of the literature search. A total of seven studies mentioning both the outcome of removed or retained syndesmotic screw were identified in the literature (Table 1). Six studies found no difference in outcome between retained or removed screws [17, 28, 32, 46–48]. In the study by Hamid et al.[47], patients with a broken screw had the highest outcome scores. Manjoo et al. [49] showed a less favorable outcome in retained screws that were intact, but screws that were broken or showed loosening had similar outcome as removed screws. In these seven studies, the time of removal was 3 months on average [17, 28, 32, 46–49]. Manjoo et al. [49] recommended screw removal only when still intact after 6 months.Fig. 1

Bottom Line: A total of seven studies were identified in the literature.Most studies found no difference in outcome between retained or removed screws.Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre, Room H-822k, PO Box 2040, CA 3000 Rotterdam, The Netherlands. t.schepers@erasmusmc.nl

ABSTRACT

Introduction: Syndesmotic positioning screws are frequently placed in unstable ankle fractures. Many facets of adequate placement techniques have been the subject of various studies. Whether or not the syndesmosis screw should be removed prior to weight-bearing is still debated. In this study, the recent literature is reviewed concerning the need for removal of the syndesmotic screw.

Materials and methods: A comprehensive literature search was conducted in the electronic databases of the Cochrane Library, Pubmed Medline and EMbase from January 2000 to October 2010.

Results: A total of seven studies were identified in the literature. Most studies found no difference in outcome between retained or removed screws. Patients with screws that were broken, or showed loosening, had similar or improved outcome compared to patients with removed screws. Removal of the syndesmotic screws, when deemed necessary, is usually not performed before 8-12 weeks.

Conclusion: There is paucity in randomized controlled trials on the absolute need for removal of the syndesmotic screw. However, current literature suggests that it might be reserved for intact screws that cause hardware irritation or reduced range of motion after 4-6 months.

Show MeSH
Related in: MedlinePlus