Hamid N, Loeffler BJ, Braddy W et al. J Bone Joint Surg Br 2009;91:1069–73.
In this review of patients with intact, broken, or removed syndesmosis screws after fixation of ankle fractures and associated syndesmosis injuries, patients with broken screws had the best functional and pain-related outcomes. However, the study had a number of limitations.
Ankle fractures are common, often with concomitant disruption of the distal tibiofibular joint at the syndesmosis. This is generally addressed during fixation of the primary fracture so as to avoid a poor subsequent outcome. While it is accepted that reduction of the syndesmosis followed by fixation with a screw enables healing, there is no consensus about the specific screw position or size needed, or about whether the screw should be removed after the syndesmosis has healed. Retaining the syndesmosis screw in the long term has been associated with poor outcomes, and hence the use of bioabsorbable and tightrope alternatives is gaining popularity.