Immediate Improvement in Physical Function after Symptomatic Syndesmotic Screw Removal

Abstract

Category: Ankle, Trauma Introduction/Purpose: The purpose of this study was to investigate the immediate impact of removing symptomatic syndesmotic screws on PROMIS outcomes and ankle range of motion (ROM) in patients who had previously undergone ankle fracture open reduction and internal fixation (ORIF) and syndesmotic fixation and later experienced symptomatic syndesmotic screws and functional limitation. Methods: A total of 346 ankle fractures were treated from February 2015 to May of 2018. 58 patients with ankle fractures with syndesmotic instability and fixation who underwent syndesmotic screw removal (SSR) were included in the analysis. Cohort data was collected for 71 patients who underwent ORIF with syndesmotic fixation, but without screw removal during the same study period. Results: Patients who underwent SSR had a statistically significant improvement in the physical function (PF) T-score to 44.5 (p<0.01) in the early post-operative period (average 48 days) after screw removal. The screw removal occurred an average of 184 days after initial ORIF. This PF T-score change also met the minimally clinically important difference. There was no significant difference in PF T-scores between the SSR group and cohort comparison group (44.5 vs 41.6; p=0.06) after screw removal. Removal of symptomatic implants resulted in an early improvement of total arc ankle ROM by 20° (p<0.01). Conclusion: There was an early clinically meaningful and statistically significant improvement in physical function outcomes and ankle ROM after symptomatic syndesmotic screw removal for patients who underwent ankle fracture ORIF with syndesmotic fixation. The final outcomes after screw removal in these patients was similar to the outcomes of asymptomatic patients who did not require syndesmotic screw removal within the same post-operative timeframe.