What Is a Syndesmotic Screw?

A syndesmotic screw is an orthopedic fixation device a doctor may recommend for the management of an unstable ankle fracture or severe sprain. The screw keeps the tibia and fibula in position while the patient’s injury heals. When the patient recovers, the doctor can remove the screw and the patient may be able to put weight on the site of the injury. Usually installation and removal of a syndesmotic screw are performed by an orthopedic surgeon or foot and ankle specialist to achieve the best possible outcome.
Before any kind of fixation device is used to address a fracture or severe sprain, the doctor will usually request medical imaging studies to learn more about the exact nature of the injury. Doctors can also palpate the joint to determine the level of flexibility and pain at the site. They may also interview their patients and have them walk to learn more about the severity of the injury. If a syndesmotic screw would be advisable, the doctor can perform a surgery to insert it.
Depending on the nature of the injury, the doctor may need to reduce a fracture at the same time as the surgery. Other fixation devices may also be necessary to stabilize the bones and hold them in place while the fracture heals. Typically the patient receives a cast or brace to immobilize the joint. As the patient heals, this can be removed, although the patient still cannot put weight on the affected ankle. After a follow-up evaluation, the doctor can remove the syndesmotic screw.
Screw removal is not always recommended. Studies on patients with syndesmotic screws suggest that while they can cause pain and mobility problems in some patients, they do not cause any issues in others. If a patient has no medical indications that would suggest it would be advisable to take the screw out, the doctor may recommend leaving it in place. In the event problems develop in the future, it can always be taken out.
Potential risks of a syndesmotic screw can include infections at the surgical site; improper alignment of the bones, which might exacerbate the injury; and chronic pain or irritation. An experienced care provider can minimize the risk of side effects as much as possible. Patients should follow aftercare instructions, especially directions about physical activity, to reduce the chances of experiencing side effects and to promote rapid, even healing of the involved ankle joint.

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