[Ortho] Систематический обзор - надо ли рутинно удалять синдесмозный винт?

[Alexander Chelnokov]

Should syndesmotic screws be removed after surgical fixation of unstable 
ankle fractures? a systematic review.

Bone Joint J. 2016 Nov;98-B(11):1497-1504.

Dingemans SA(1), Rammelt S(2), White TO(3), Goslings JC(1), Schepers T(1).

Author information:

(1)Trauma Unit, Department of Surgery, Academic Medical Center, 
Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
(2)UniversitätsCentrum für Orthopädie und Unfallchirurgie, 
Universitätsklinikum "Carl Gustav Carus" TU Dresden, Fetscherstrasse 74, 
01307 Dresden, Germany.
(3)Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 
51 Little France Cres, Edinburgh EH16 4SA, UK.



AIMS: In approximately 20% of patients with ankle fractures, there is an 
concomitant injury to the syndesmosis which requires stabilisation, 
usually with one or more syndesmotic screws. The aim of this review is 
to evaluate whether removal of the syndesmotic screw is required in 
order for the patient to obtain optimal functional recovery.



MATERIALS AND METHODS: A literature search was conducted in Medline, 
Embase and the Cochrane Library for articles in which the syndesmotic 
screw was retained. Articles describing both removal and retaining of 
syndesmotic screws were included. Excluded were biomechanical studies, 
studies not providing patient related outcome measures, case reports, 
studies on skeletally immature patients and reviews. No restrictions 
regarding year of publication and language were applied.


RESULTS: A total of 329 studies were identified, of which nine were of 
interest, and another two articles were added after screening the 
references. In all, two randomised controlled trials (RCT) and nine 
case-control series were found. The two RCTs found no difference in 
functional outcome between routine removal and retaining the syndesmotic 
screw. All but one of the case-control series found equal or better 
outcomes when the syndesmotic screw was retained. However, all
included studies had substantial methodological flaws.


CONCLUSIONS: The currently available literature does not support routine 
elective removal of syndesmotic screws. However, the literature is of 
insufficient quality to be able to draw definitive conclusions. 
Secondary procedures incur a provider and institutional cost and expose 
the patient to the risk of complications.
Therefore, in the absence of high quality evidence there appears to be 
little justification for routine removal of syndesmotic screws.

   Cite this article: Bone
Joint J 2016;98-B:1497-1504.


©2016 The British Editorial Society of Bone& Joint Surgery.


DOI: 10.1302/0301-620X.98B11.BJJ-2016-0202.R1
PMID: 27803225  [PubMed - in process]

Alexander Chelnokov

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