A Systematic Review of the Routine Removal of Syndesmosis Screws in Traumatic Ankle Fractures

The ankle syndesmosis is a critical structure, conferring a great degree of stability to the ankle mortise comprising part of a complex framework of ligaments responsible for 90% of the resistance to lateral displacement of the fibula [1]. The components of the syndesmosis are the Anterior-Inferior Tibiofibular Ligament (AITFL), Posterior- Inferior Tibiofibular Ligament (PITFL), Transverse Tibiofibular Ligament (TTFL) and Interosseous Ligament (IOL). With approximately one in seven ankle fractures associated with a syndesmotic injury it is a common pattern [2]. The injury itself is most often found intra-operatively after stable fixation of malleolar fractures, indicated by persistent instability. This instability is often dealt with through the use of a bridging syndesmotic screw which restores the ankle mortise, confers stability but leaves the original syndesmotic injury relatively untouched.