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

Abstract

To compare the outcomes of Weber C ankle fractures treated with syndesmotic screw fixation where the screw was removed prior to weight bearing against those where the screw was left in situ indefinitely. Retrospective observational analysis of a consecutive series. Acute tertiary hospital. Thirty-three patients with ankle fractures and syndesmotic disruption were treated with open reduction, internal fixation, and syndesmotic stabilisation with a syndesmotic screw. Three patients defaulted follow-up after 1-3 months. In the remaining 30, the syndesmotic screw was removed prior to weight bearing in 23 patients and was left in situ in 7 patients. Mean follow-up was 15 months. Assessment with subjective, objective, and radiographic criteria was used. Statistical analysis was performed with independent groups t-test and chi-square test. There was no statistically significant difference between ankle scores, functional outcome or range of motion between the two groups. However, there was a significantly higher incidence of syndesmotic screw breakage and osteolysis in the group where screws were retained. Judicious fixation of Weber C type injuries with syndesmotic screw fixation allows for good functional outcome. Retaining of the syndesmotic screw on commencement of weight bearing seems to increase the risk of subsequent screw breakage. Removal of the screw prior to weight bearing should be performed to avoid such an eventuality.