Routine Removal of Syndesmotic Screws After Tibiofibular Syndesmosis Fixation Does Not Affect Patient Function and Is Associated with a Higher Risk of Postoperative Complications

<b>Background:</b> Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its clinical relevance. <b>Methods:</b> This retrospective observational study included 330 patients treated surgically for tibiofibular syndesmosis injuries at a single institution from 2016 to 2024. Patients were categorized into three groups: no removal, routine removal, and removal for clinical indications. Functional outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), and complications, including infections and prolonged pain, were recorded. Statistical analyses evaluated differences between groups. <b>Results:</b> Of the 170 patients who completed follow-up, no significant differences in OMASs were found between the groups (<i>p</i> = 0.646). Complications were more frequent in reoperated patients (9% vs. 2% for non-reoperated), but routine removal did not improve functional outcomes. Younger patients showed better OMASs, highlighting age as a key factor in recovery. Fixation and fracture types had no significant impact on outcomes. <b>Conclusions:</b> Routine syndesmosis screw removal offers no significant functional benefits, as demonstrated by comparable OMASs across groups (median OMAS: 85 for non-reoperated, 80 for routinely reoperated, and 80 for indication-based reoperated patients). However, routine removal is associated with a higher complication rate. A selective approach focusing on clinical indications is recommended to minimize unnecessary surgeries and optimize patient outcomes. Future research should focus on redefining evidence-based management strategies for syndesmotic fixation.