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Functional Outcomes After Syndesmotic Screw Fixation and Removal

Miller, Anna N MD*; Paul, Omesh MD*; Boraiah, Sreevathsa MD†; Parker, Robert J BS*; Helfet, David L MD*; Lorich, Dean G MD*

Journal of Orthopaedic Trauma: January 2010 - Volume 24 - Issue 1 - pp 12-16
doi: 10.1097/BOT.0b013e3181c6e199
Original Article

Objectives: Ankle fractures with a syndesmotic injury have historically been treated with syndesmotic screw fixation. We compared range of motion and functional outcomes' scores to assess patient benefit from syndesmotic screw and plate removal.

Design: Level IV-case series.

Setting: Level I-trauma center.

Patients/Participants: Twenty-five consecutive patients with unstable ankle fractures and syndesmotic injury confirmed on magnetic resonance imaging.

Intervention: Locked syndesmotic screws and plates were removed; functional outcomes and range of motion were measured before and after screw removal.

Main Outcome Measurements: Foot and Ankle Outcome Score, Olerud and Molander Ankle Score, and physical examination

Results: There was a significant improvement in range of motion, Foot and Ankle Outcome, and Olerud and Molander Ankle scores at the immediate postoperative visit. This was not significantly changed at longer follow-up. There were no adverse events or complications in these patients. No patient had radiographic loss of syndesmotic reduction after screw removal.

Conclusions: Locked screw and plate removal improved function both subjectively and objectively. Transsyndesmotic implant removal seems to assist improvements in the speed of rehabilitation.

From the *Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY; and †Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY.

Accepted for publication October 20, 2009.

The authors have no sources of support, pharmaceutical, industry, or otherwise to acknowledge. They are not testing any devices for market approval. They did not receive funding from National Institutes of Health, Wellcome Trust, or the Howard Hughes Medical Institute.

This study was presented in part as a poster presentation at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Las Vegas, Nevada, 2009.

Reprints: Anna N. Miller, MD, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.