Evaluation of the clinical and radiological outcomes of syndesmotic screws not parallel to the ankle joint.

Abstract

Purpose: This study aimed to evaluate the clinical and radiological outcomes of parallel and non-parallel placements of a single syndesmotic screw relative to the ankle joint line in the coronal plane used to enhance tibiofibular stability after syndesmosis injuries in ankle trauma surgery.

Methods: Eighty-nine patients with isolated Weber B and C fractures treated from January 2021 to December 2024 were evaluated. They were divided into two groups based on the angulation of the syndesmotic screw: Group 1 (49 patients) had screws angled between -3° and +3° (parallel), while Group 2 (40 patients) had nonparallel screws. Comparisons were made on surgical duration, fluoroscopic shots needed for fixation, intraoperative fluoroscopic shots, postoperative medial clear space, ankle range of motion (ROM) at 3 and 6 months, American Orthopaedic Foot and Ankle Society (AOFAS) scores at those intervals, rates of implant fracture or failure, and radiolucencies around implants.

Results: The angulation of the syndesmotic screw was significantly different between the groups, measuring 1.87 ± 0.77 in Group 1 and 4.66 ± 1.68 in Group 2 (p < 0.001). Surgical duration averaged 51.32 ± 7.71 minutes in Group 1 compared to 40.62 ± 6.75 minutes in Group 2 (p = 0.027). At 3 months, ankle ROM was 32.95 ± 4.11 in Group 1 and 30.55 ± 3.44 in Group 2 (p = 0.026), but no significant difference was found at 6 months (p = 0.078). AOFAS scores showed significant differences at 3 months (p < 0.001) but not at 6 months (p = 0.862) CONCLUSION: The study found that syndesmotic screws placed parallel or nonparallel to the joint in the coronal plane had similar clinical outcomes.