LONG-SEGMENT SPINAL FIXATION USING PELVIC SCREWS

ABSTRACT OBJECTIVE Long spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. METHODS Twenty consecutive patients who underwent spinal-pelvic fixation were followed over a 3-year period (2004–2007). The patient population consisted of 11 men and 9 women with an average age of 58.8 years. Indications for spinal-pelvic fixation in this series included kyphoscoliosis, lumbosacral pseudoarthrosis, sacral fractures, lumbosacral spondylolisthesis, sacral tumors, and lumbar osteomyelitic fractures. Radiographic outcomes were assessed using flexion-extension x-rays and computed tomographic scans. Clinical outcomes were assessed using Odom's criteria and modified Prolo scale. RESULTS One patient was lost to radiographic follow-up. One patient died after surgery. The mean follow-up for the remaining patients was 13 months (range, 1–21 mo). Odom's outcomes were rated as good to excellent in 11 (58%), fair in 7 (37%), and poor in 1 (5%) (one patient died). Preoperative and postoperative modified Prolo scores were 10.4 and 12.9, respectively (mean improvement, 2.5). Radiographic fusion across the lumbosacral junction was obtained in 16 (89%) of the 18 patients with follow-up. One patient required revision of a pelvic screw. There was one infection requiring explantation of hardware. CONCLUSION Pelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.

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The Reconstruction Accuracy of the Hip Center of Rotation After Cementless Total Hip Arthroplasty for Failed Treatment of Acetabular Fractures. Does It Matter?

10.21203/rs.3.rs-1057572/v1 ◽

2021 ◽

Author(s):

Liang Zhang ◽

Mingxue Chen ◽

Zhuyi Ma ◽

Tao Bian ◽

Shaoliang Li ◽

...

Keyword(s):

Harris Hip Score ◽

Acetabular Fractures ◽

X Rays ◽

Reconstruction Accuracy ◽

Center Of Rotation ◽

Total Hip ◽

Radiographic Outcomes ◽

Negative Effect ◽

Hip Arthroplasties

Abstract Background To assess the impaction of reconstruction accuracy of hip center of rotation (COR) on midterm clinical and radiographic results of cementless reconstruction of total hip arthroplasties (THAs) for patients after failed treatment of acetabular fractures. Methods One hundred and four patients (107 hips) who underwent THAs after failed treatment of acetabular fractures were retrospectively evaluated and cementless cups and stems were implanted in all hips. Clinical outcomes were assessed using the Harris hip score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scoring system. Radiographic results were analyzed by serial perioperative x-rays. Results At the latest follow-up examination, the median HHS increased from 52 (42-65) before surgery to 93 (90-97) (p < 0.001) and the median WOMAC decreased from 52 (36-65) before surgery to 5.8 (1.5-8) (p < 0.001). Compared with normal contralateral hip, 79 cups migrated superiorly (0.2-33.6mm) and 22 cups migrated inferiorly (0.2-16.1mm). The distance of superior migration of reconstructed COR was correlated with positive Trendelenburg sign at the latest follow-up examination (r=0.504; p < 0.001). The percentage of postoperative Trendelenburg sign was significantly higher in superior migration subgroup than that in subgroup with anatomical restoration of COR (P=0.015). Conclusions Cementless THAs in patients after failed treatment for acetabular fractures achieved predictable clinical and radiographic outcomes. A superiorly migrated hip COR appeared to exert a negative effect on abductor muscle function.

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A biomechanical investigation of the sacroiliac joint in the setting of lumbosacral fusion: impact of pelvic fixation versus sacroiliac joint fixation

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine181127 ◽

2019 ◽

Vol 31 (4) ◽

pp. 562-567 ◽

Cited By ~ 2

Author(s):

Harry Mushlin ◽

Daina M. Brooks ◽

Joshua Olexa ◽

Bryan J. Ferrick ◽

Stephen Carbine ◽

...

Keyword(s):

Sacroiliac Joint ◽

Screw Fixation ◽

Intact Specimen ◽

Lumbosacral Fusion ◽

Pelvic Fixation ◽

Biomechanical Investigation ◽

Flexion Extension ◽

Iliac Screw ◽

Sacroiliac Fusion ◽

Bending Modes

OBJECTIVEThe sacroiliac joint (SIJ) is a known source of low-back pain. Randomized clinical trials support sacroiliac fusion over conservative management for SIJ dysfunction. Clinical studies suggest that SIJ degeneration occurs in the setting of lumbosacral fusions. However, there are few biomechanical studies to provide a good understanding of the effect of lumbosacral fusion on the SIJ. In the present study, researchers performed a biomechanical investigation to discern the effect of pelvic versus SIJ fixation on the SIJ in lumbosacral fusion.METHODSSeven fresh-frozen human cadaveric specimens were used. There was one intact specimen and six operative constructs: 1) posterior pedicle screws and rods from T10 to S1 (PS); 2) PS + bilateral iliac screw fixation (BIS); 3) PS + unilateral iliac screw fixation (UIS); 4) PS + UIS + 3 contralateral unilateral SIJ screws (UIS + 3SIJ); 5) PS + 3 unilateral SIJ screws (3SIJ); and 6) PS + 6 bilateral SIJ screws (6SIJ). A custom-built 6 degrees-of-freedom apparatus was used to simulate three bending modes: flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Range of motion (ROM) was recorded at L5–S1 and the SIJ.RESULTSAll six operative constructs had significantly reduced ROM at L5–S1 in all three bending modes compared to that of the intact specimen (p < 0.05). In the FE mode, the BIS construct had a significant reduction in L5–S1 ROM as compared to the other five constructs (p < 0.05). SIJ ROM was greatest in the FE mode compared to LB and AR. Although the FE mode did not show any statistically significant differences in SIJ ROM across the constructs, there were appreciable differences. The PS construct had the highest SIJ ROM. The BIS construct reduced bilateral SIJ ROM by 44% in comparison to the PS construct. The BIS and 6SIJ constructs showed reductions in SIJ ROM nearly equal to those of the PS construct. UIS and 3SIJ showed an appreciable reduction in unfused SIJ ROM compared to PS.CONCLUSIONSThis investigation demonstrated the effects of various fusion constructs using pelvic and sacroiliac fixation in lumbosacral fusion. This study adds biomechanical evidence of adjacent segment stress in the SIJ in fusion constructs extending to S1. Unilateral pelvic fixation, or SIJ fusion, led to an appreciable but nonsignificant reduction in the ROM of the unfused contralateral SIJ. Bilateral pelvic fixation showed the greatest significant reduction of movement at L5–S1 and was equivalent to bilateral sacroiliac fusion in reducing SIJ motion.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00080 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0008

Author(s):

Mohamed E. Abdelaziz ◽

Noortje Hagemeijer ◽

Daniel Guss ◽

Ahmed El-Hawary ◽

A. Holly Johnson ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Ankle, Sports, Trauma, Syndesmosis Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (ROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond (Figure 1). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00001 ◽

2020 ◽

Vol 5 (2) ◽

pp. 2473011420S0000

Author(s):

Mohamed Abdelaziz ◽

Daniel Guss ◽

Anne H. Johnson ◽

Christopher DiGiovanni ◽

Noortje Hagemeijer ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Trauma; Ankle; Sports Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (PROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond ( Figure 1 ). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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Clinical outcomes and complications following primary total elbow arthroplasty using the Latitude prosthesis

Shoulder & Elbow ◽

10.1177/1758573218768510 ◽

2018 ◽

Vol 11 (5) ◽

pp. 359-371 ◽

Cited By ~ 1

Author(s):

David Cinats ◽

Aaron J Bois ◽

Kevin A Hildebrand

Keyword(s):

Range Of Motion ◽

Clinical Outcomes ◽

Total Elbow Arthroplasty ◽

Published Data ◽

Mayo Elbow Performance Score ◽

Elbow Arthroplasty ◽

Radiographic Outcomes ◽

Flexion Extension ◽

Functional Outcome Measures

Background The Latitude total elbow arthroplasty (TEA) is an implant with limited published data on its performance and outcomes. The aim of this study was to report the short-term outcomes of the Latitude TEA as well as to describe the radiographic outcomes and complications. Methods The Latitude was implanted in 20 patients (23 elbows) in a linked configuration. Patients were recalled to clinic for the assessment of their range-of-motion and compared to preoperative values. Administration of functional outcome measures was also performed. Results Mean follow-up was 4.7 years (range, 1 to 7.5 years) with four elbows requiring revision. The flexion–extension arc improved from 86.6 to 101.3 (range, 76 to 126) postoperatively (p = 0.04). The average Disabilities of the Arm, Shoulder, and Hand score was 28.1 (range, 5.8 to 50.4) and the average Mayo Elbow Performance Score was 89.6 (range, 76 to 100), with 83% of elbows scoring in the good or excellent range. Radiolucencies were detected in 60% of patients and 31% of these lucencies progressed in size at the time of follow-up. Conclusions The Latitude prosthesis provides patients with favorable clinical outcomes with improvements in their range-of-motion and a complication rate comparable to other elbow arthroplasty implants.

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Infection after the use of INFIX in Pelvic Ring Injuries

SICOT-J ◽

10.1051/sicotj/2021047 ◽

2021 ◽

Vol 7 ◽

pp. 46

Author(s):

Rahul Vaidya ◽

Karun Amar ◽

Derrek Woodbury ◽

Austen Washington

Keyword(s):

Pelvic Ring ◽

X Rays ◽

Pelvic Fixation ◽

Pelvic Ring Injuries ◽

Small Series ◽

Loss Of Reduction ◽

Irrigation And Debridement ◽

Radiographic Union

Introduction: The purpose of this study is to report on infection with anterior subcutaneous internal pelvic fixation (INFIX) for pelvic ring injuries and the outcomes of treatment. Methods: An IRB-approved retrospective study was performed using trauma databases of a level one and level two trauma center from 2012–2018. Infection after the INFIX procedure was diagnosed in 10 of 179 cases. Treatment included formal irrigation and debridement, removal of the hardware, and culture-specific antibiotics. Patients were followed for a minimum of 12 months. Recorded outcomes include X-rays, Majeed scores, and the presence of any loss of reduction using reduction parameters. Results: Time to detect the infection was 54.2 ± 24.3 days (range 24–90, median 56 days). Staphylococcus aureus was the most common bacteria isolated. The average follow-up was 830 ± 170 days (range 575–1088 days). All patients went on to the radiographic union. There were no recurrent infections or osteomyelitis at the latest follow-up. Patients maintained their reduction after INFIX removal (KI), and Majeed scores ranged from 72 to 96 (seven good, three excellent). Discussion: Infections after using the INFIX procedure were dealt with by irrigating and debriding the wounds, removing the INFIX with culture-specific antibiotics for 2–6 weeks. Implants were maintained for at least 25 days, and there was no loss of reduction. There were no long-term sequelae noted in this small series or the literature review included in this paper.

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Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419841253 ◽

2019 ◽

Vol 44 (6) ◽

pp. 594-599 ◽

Cited By ~ 3

Author(s):

Bo Liu ◽

Feiran Wu ◽

Chye Yew Ng

Keyword(s):

Bone Grafting ◽

Screw Fixation ◽

Wrist Arthroscopy ◽

Scaphoid Bone ◽

Percutaneous Screw Fixation ◽

Level Of Evidence ◽

Flexion Extension ◽

The Mean ◽

Dorsal Intercalated Segment Instability

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. All fractures united. At a mean follow-up of 21 months (range 12–48), the mean Mayo wrist score was 96, and patient-rated wrist evaluation was 4, and the flexion–extension arc was 90% of the contralateral wrist. We conclude that arthroscopy is valuable in the treatment of scaphoid delayed or nonunions and in judging the need for bone grafting. Our data indicate that regardless of cystic formation in the scaphoid, bone grafting is not always necessary. Percutaneous fixation alone is sufficient when scaphoid delayed or nonunions are between 8 weeks and 1 year following injury, without scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and when forceful probing confirms stability of the scaphoid arthroscopically. Level of evidence: IV

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Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws

Operative Neurosurgery ◽

10.1093/ons/opaa251 ◽

2020 ◽

Vol 20 (1) ◽

pp. 91-97

Author(s):

Seung-Jae Hyun ◽

Jong-myung Jung ◽

Ki-Jeong Kim ◽

Tae-Ahn Jahng

Keyword(s):

Clinical Outcomes ◽

Screw Fixation ◽

Patient Characteristics ◽

Shaft Fracture ◽

Consecutive Series ◽

Computed Tomographic ◽

Spinopelvic Fixation ◽

Iliac Screws ◽

Failure Types

Abstract BACKGROUND S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation. OBJECTIVE To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery. METHODS A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a ≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. RESULTS In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients. CONCLUSION The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.

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SAFE ANGLE SCOPE FOR POSTERIOR ATLANTO-OCCIPITAL TRANSARTICULAR SCREW FIXATION

Neurosurgery ◽

10.1227/01.neu.0000350901.60969.2d ◽

2009 ◽

Vol 65 (3) ◽

pp. 499-504 ◽

Cited By ~ 2

Author(s):

Wangjun Yan ◽

Chengshi Zhang ◽

Xuhui Zhou ◽

Xiongsheng Chen ◽

Wen Yuan ◽

...

Keyword(s):

Sagittal Plane ◽

Screw Fixation ◽

Tomographic Reconstruction ◽

Kirschner Wire ◽

Screw Placement ◽

X Rays ◽

Transarticular Screw ◽

Transarticular Screw Fixation ◽

Computed Tomographic ◽

Fresh Cadaver

Abstract OBJECTIVE To study the technical parameters related to, and explore the clinical significance of, posterior atlanto-occipital transarticular screw fixation. METHODS Posterior implantation of Kirschner wires via the atlanto-occipital joint was performed on 20 dry bone specimens with complete atlanto-occipital joints. The angle of the Kirschner wire was measured on a postimplantation x-ray. Three-dimensional computed tomographic reconstruction of the atlanto-occipital joint of 30 healthy adults was performed to measure the simulative safety range for screw placement in posterior atlanto-occipital transarticular screw fixation. The procedure was then conducted on 12 fresh cadaver occipitocervical specimens. X-rays and 3-dimensional computed tomographic reconstruction were performed postsurgery to verify exact screw positioning. RESULTS The ideal angles for screw placement were cephalocaudal angle in the sagittal plane of 53.3 ± 3.4 degrees, mediolateral angle in the coronal plane of 20.0 ± 2.6 degrees, a maximum allowable cephalocaudal angle of 74.6 ± 2.8 degrees (67.9–80.5 degrees), a minimum allowable cephalocaudal angle of 24.9 ± 1.9 degrees (22.1–29.4 degrees), a maximum allowable mediolateral angle of 40.5 ± 2.9 degrees (31.1–49.4 degrees), and a minimum allowable mediolateral angle of 0.7 ± 1.6 degrees (−4.1–5.9 degrees). Surgery simulation in the fresh cadaver specimens indicated that this safe scope is reliable. CONCLUSION There is a safe scope for the angle of the screw placement in posterior atlanto-occipital transarticular screw fixation. Posterior transarticular screw fixation can be safely performed for occipitocervical fusion fixation when utilizing careful screw placement.

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Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000067 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Cristian Ortiz ◽

Andres Keller Díaz ◽

Pablo Mococain ◽

Pablo Wagner ◽

Ruben Radkievich ◽

...

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Ankle Fractures ◽

X Rays ◽

Aofas Score ◽

Early Weight Bearing ◽

Clear Space ◽

Screw Breakage ◽

The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

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