Acevedo Daniel, Suarez Andy, Kaur Kiranjit, Checkley Taylor, Jimenez Pedro, MacMahon Aoife, Vulcano Ettore, Aiyer Amiethab A
Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 3200 S University Drive, Davie, FL, 33328, USA.
The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
J Orthop. 2024 Mar 22;54:136-142. doi: 10.1016/j.jor.2024.03.012. eCollection 2024 Aug.
Syndesmotic injuries are frequently stabilized using syndesmotic screws. Traditionally, these screws were routinely removed during the postoperative period, however recent literature has brought into question the necessity of routine removal, citing no change in functional outcomes and the inherent risks of a second surgery. Our study aimed to compare outcomes of patients undergoing routine syndesmotic screw removal versus those undergoing an on-demand approach to removal.
A systematic search of studies comparing routine syndesmotic screw removal to on-demand screw removal following an acute ankle fracture, or an isolated syndesmotic injury was conducted across seven databases. Only Prospective randomized controlled trials were eligible for inclusion. Data reported on by at least 2 studies was pooled for analysis.
Three studies were identified that met inclusion and exclusion criteria. No significant difference in Olerud-Molander Ankle Score (MD -2.36, 95% CI -6.50 to 1.78, p = 0.26), American Orthopedic Foot and Ankle Hindfoot Score (MD -0.45, 95% CI -1.59 to .69, p = 0.44), or dorsiflexion (MD 2.20, 95% CI -0.50 to 4.89, p = 0.11) was found between the routine removal group and on-demand removal group at 1-year postoperatively. Routine removal was associated with a significantly higher rate of complications than on-demand removal (RR 3.02, 95% CI 1.64 to 5.54, p = 0.0004). None of the included studies found significant differences in pain scores or range of motion by 1-year postoperatively.
Given the increased risk of complications with routine syndesmotic screw removal and the comparable outcomes when screws are retained, an as-needed approach to syndesmotic screw removal should be considered.
下胫腓联合损伤常使用下胫腓联合螺钉进行固定。传统上，这些螺钉在术后常规取出，然而最近的文献对常规取出的必要性提出了质疑，理由是功能结局没有变化以及二次手术存在固有风险。我们的研究旨在比较接受下胫腓联合螺钉常规取出的患者与接受按需取出方法的患者的结局。
在七个数据库中对比较急性踝关节骨折或孤立的下胫腓联合损伤后下胫腓联合螺钉常规取出与按需取出的研究进行了系统检索。仅前瞻性随机对照试验符合纳入标准。对至少两项研究所报告的数据进行汇总分析。
确定了三项符合纳入和排除标准的研究。术后1年时，常规取出组与按需取出组在奥勒鲁德-莫兰德踝关节评分（MD -2.36，95%CI -6.50至1.78，p = 0.26）、美国矫形足踝后足评分（MD -0.45，95%CI -1.59至0.69，p = 0.44）或背屈（MD 2.20，95%CI -0.50至4.89，p = 0.11）方面未发现显著差异。常规取出与比按需取出显著更高的并发症发生率相关（RR 3.02，95%CI 1.64至5.54，p = 0.0004）。纳入的研究均未发现术后1年时疼痛评分或活动范围有显著差异。
鉴于下胫腓联合螺钉常规取出的并发症风险增加且保留螺钉时结局相当，应考虑采用按需取出下胫腓联合螺钉的方法。
