Syndesmosis Fixation with Rigid Synthesis in Weber B and C Ankle Fractures: 100 Consecutive Cases to Evaluate the Outcome of Screws and Reduction

Research Type: Level 4 – Case series Introduction/Purpose: Ankle fractures are among the most common injuries of the lower limbs. An associated disruption of the ankle syndesmosis occurs in more than 10% of these fractures. Fixation with trans-syndesmotic screws has long served as the gold standard method of tibiofibular stabilization because it is accepted to most effectively restore the anatomy and allow syndesmotic healing. However, screw fixation does not always turn out to be successful, leading to the need for operative revision following the initial operation because of screw breakage or loosening. The present study aims to evaluate the situation of syndesmosis fixation with a screw, considering the position in which it was placed (suprasyndesmal or transyndesmal), quantity of transfixed cortices, maintenance of reduction and need for removal Methods: Retrospective longitudinal analytical observational study analyzing radiographs of patients with ankle fractures with syndesmosis injury, of both sexes, treated surgically in a tertiary hospital. The sample consisted of 100 consecutive cases, with the primary outcome of the syndesmal screw being assessed, considering breakage, failure and the need for removal, in addition to the assessment of reduction parameters in the immediate postoperative period and in the last radiograph performed in the outpatient segment. Results: In this study, it was observed that there is no difference in relation to the type of fracture (Weber B or C) and the prevalence of screw removal. Considering the position of the screw, in our serie, the suprasyndesmal screw was involved with a higher complication rate and consequently a greater need for removal. We found no loss of reduction in the patients that were submited to screw removal, comparing pre and post operative radiographic parameters Conclusion: There is no guideline or consensus on when to remove the screw or whether it is even necessary. Removal may be helpful in cases of mechanical irritation from the screw or decreased range of motion. Suprasyndesmal screws seems to be envolved with a higher complication rate.