Department of Orthopaedics, ESI Hospital, Rohini, Delhi, India.
Department of Orthopaedics, Indian Spinal Injury Centre, Delhi, India.
Foot (Edinb). 2021 Dec;49:101776. doi: 10.1016/j.foot.2021.101776. Epub 2021 Jan 30.
Syndesmosis injuries are common with rotational ankle injuries, and placement of a positional syndesmotic screw to maintain its reduction is used as the ligaments heal. There is no clear consensus on routine removal or retention of syndesmotic screw. This study aimed to appraise the current evidence both on removal and retention of syndesmotic screw and to conduct a meta-analysis comparing outcomes and rate of complications of syndesmotic screw removal and retention.
Following PROSPERO registration, a systematic search using was performed using keywords ('Syndesmosis' OR 'Syndesmotic' OR 'Transsyndesmotic' OR 'distal tibiofibular') AND ('Screw') AND ('Removal' OR 'Retention') AND 'Outcome' in various databases. No language restrictions were applied and the meta-analysis incorporated the PRISMA statement. VAS (Visual analogue scale for pain), AOFAS (American Orthopaedic Foot And Ankle Society) scores expressed as mean ± SD, and both groups' complication rates were compared. Comparisons with a random-effects model were performed, and heterogeneity between the studies was calculated using the I2 statistic. T-test for two independent sample means was used to compare pooled mean and Z-test for two proportions to assess the difference in the proportion of complications.
A total of 7 studies with 522 patients were included in this review for analysis. Pooled analysis showed non-significant difference in AOFAS score (MD = -1.84; 95% CI: -4.33 to 0.66; p = 0.150) as well as for VAS score (MD = -0.48; 95% CI: -1.56 to 0.60; p = 0.390) between the two groups. The value of z and p-value for complication rates was 0.6021 and 0.5485, respectively, which was not significant.
There doesn't appear to be a difference in functional outcome, pain scores, and complication rates between patients who had their syndesmotic screws removed and those where screw was retained. The fear of inferior outcomes with retained screws is thus unfounded, and routine removal adds to morbidity and financial burden. In conclusion, present data does not support the routine removal of the intact syndesmosis screw, and a change in practice is needed to abandon routine syndesmotic screw removal.
踝关节旋转损伤常伴有下胫腓联合损伤，在韧带愈合过程中，常使用位置固定的下胫腓联合螺钉来维持复位。对于是否常规取出或保留下胫腓联合螺钉，目前尚无明确共识。本研究旨在评估关于取出和保留下胫腓联合螺钉的现有证据，并进行荟萃分析，比较取出和保留下胫腓联合螺钉的疗效和并发症发生率。
在 PROSPERO 注册后，使用关键词（“下胫腓联合”或“下胫腓联合”或“经下胫腓联合”或“远侧胫腓骨”）和（“螺钉”）以及（“取出”或“保留”）和“结果”在各种数据库中进行系统搜索。未应用语言限制，荟萃分析采用 PRISMA 声明。使用视觉模拟评分（VAS）评估疼痛，美国矫形足踝协会（AOFAS）评分表示为均数±标准差，并比较两组的并发症发生率。采用随机效应模型进行比较，使用 I2 统计量计算研究间的异质性。采用两独立样本均数的 t 检验比较合并均数，采用两比例 Z 检验评估并发症比例的差异。
本研究共纳入 7 项研究，共 522 例患者。荟萃分析显示，两组 AOFAS 评分（MD=-1.84；95%CI：-4.33 至 0.66；p=0.150）和 VAS 评分（MD=-0.48；95%CI：-1.56 至 0.60；p=0.390）差异无统计学意义。并发症发生率的 z 值和 p 值分别为 0.6021 和 0.5485，差异无统计学意义。
取出和保留下胫腓联合螺钉的患者在功能结果、疼痛评分和并发症发生率方面似乎没有差异。保留螺钉的不良预后的担忧是没有根据的，常规取出会增加发病率和经济负担。总之，目前的数据不支持常规取出完整的下胫腓联合螺钉，需要改变实践，放弃常规下胫腓联合螺钉取出。
