Evaluation of the clinical and radiological outcomes of syndesmotic screws not parallel to the ankle joint.

Abstract

This study aimed to evaluate the clinical and radiological outcomes of parallel and non-parallel placements of a single syndesmotic screw relative to the ankle joint line in the coronal plane used to enhance tibiofibular stability after syndesmosis injuries in ankle trauma surgery. Eighty-nine patients with isolated Weber B and C fractures treated from January 2021 to December 2024 were evaluated. They were divided into two groups based on the angulation of the syndesmotic screw: Group 1 (49 patients) had screws angled between -3° and +3° (parallel), while Group 2 (40 patients) had nonparallel screws. Comparisons were made on surgical duration, fluoroscopic shots needed for fixation, intraoperative fluoroscopic shots, postoperative medial clear space, ankle range of motion (ROM) at 3 and 6 months, American Orthopaedic Foot and Ankle Society (AOFAS) scores at those intervals, rates of implant fracture or failure, and radiolucencies around implants. The angulation of the syndesmotic screw was significantly different between the groups, measuring 1.87 ± 0.77 in Group 1 and 4.66 ± 1.68 in Group 2 (p < 0.001). Surgical duration averaged 51.32 ± 7.71 minutes in Group 1 compared to 40.62 ± 6.75 minutes in Group 2 (p = 0.027). At 3 months, ankle ROM was 32.95 ± 4.11 in Group 1 and 30.55 ± 3.44 in Group 2 (p = 0.026), but no significant difference was found at 6 months (p = 0.078). AOFAS scores showed significant differences at 3 months (p < 0.001) but not at 6 months (p = 0.862) CONCLUSION: The study found that syndesmotic screws placed parallel or nonparallel to the joint in the coronal plane had similar clinical outcomes.