Functional outcome of routine versus on-demand removal of the syndesmotic screw.
Journal
Bone & joint open
ISSN: 2633-1462
Titre abrégé: Bone Jt Open
Pays: England
ID NLM: 101770336
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
medline:
18
12
2023
pubmed:
18
12
2023
entrez:
18
12
2023
Statut:
epublish
Résumé
The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.
Identifiants
pubmed: 38108322
doi: 10.1302/2633-1462.412.BJO-2023-0061
pii: BJO-2023-0061
doi:
Types de publication
Journal Article
Langues
eng
Pagination
957-963Informations de copyright
© 2023 Schepers et al.
Déclaration de conflit d'intérêts
As per the funding information and open access funding, the authors disclose funding for the APC from ZonMW, under project number 843002705.
Références
Egol KA , Pahk B , Walsh M , Tejwani NC , Davidovitch RI , Koval KJ . Outcome after unstable ankle fracture: effect of syndesmotic stabilization . J Orthop Trauma . 2010 ; 24 ( 1 ): 7 – 11 . 10.1097/BOT.0b013e3181b1542c 20035171
van den Bekerom MPJ , Lamme B , Hogervorst M , Bolhuis HW . Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg . 2007 ; 46 ( 6 ): 456 – 463 . 10.1053/j.jfas.2007.08.009 17980843
Schepers T , van Zuuren WJ , van den Bekerom MPJ , Vogels LMM , van Lieshout EMM . The management of acute distal tibio-fibular syndesmotic injuries: results of a nationwide survey . Injury . 2012 ; 43 ( 10 ): 1718 – 1723 . 10.1016/j.injury.2012.06.015 22795845
Bell DP , Wong MK . Syndesmotic screw fixation in Weber C ankle injuries--should the screw be removed before weight bearing? Injury . 2006 ; 37 ( 9 ): 891 – 898 . 10.1016/j.injury.2006.02.003 16630621
Miller AN , Paul O , Boraiah S , Parker RJ , Helfet DL , Lorich DG . Functional outcomes after syndesmotic screw fixation and removal . J Orthop Trauma . 2010 ; 24 ( 1 ): 12 – 16 . 10.1097/BOT.0b013e3181c6e199 20035172
Penning D , Birnie MF , Sanders FR , de Ruiter KJ , Schepers T . Syndesmotic screw: where does it break? J Foot Ankle Surg . 2021 ; 8 ( 4 ): 168 – 171 . 10.5005/jp-journals-10040-1184
Sanders FRK , Birnie MF , Dingemans SA , et al. Functional outcome of routine versus on-demand removal of the syndesmotic screw: a multicentre randomized controlled trial . Bone Joint J . 2021 ; 103-B ( 11 ): 1709 – 1716 . 10.1302/0301-620X.103B11.BJJ-2021-0348.R2 34719269
Olerud C , Molander H . A scoring scale for symptom evaluation after ankle fracture . Arch Orthop Trauma Surg (1978) . 1984 ; 103 ( 3 ): 190 – 194 . 10.1007/BF00435553 6437370
Kitaoka HB , Alexander IJ , Adelaar RS , Nunley JA , Myerson MS , Sanders M . Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes . Foot Ankle Int . 1994 ; 15 ( 7 ): 349 – 353 . 10.1177/107110079401500701 7951968
Lehtola R , Leskelä H-V , Flinkkilä T , et al. Suture button versus syndesmosis screw fixation in pronation-external rotation ankle fractures: A minimum 6-year follow-up of A randomised controlled trial . Injury . 2021 ; 52 ( 10 ): 3143 – 3149 . 10.1016/j.injury.2021.06.025 34246483
Ræder BW , Figved W , Madsen JE , Frihagen F , Jacobsen SB , Andersen MR . Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial . Bone Joint J . 2020 ; 102-B ( 2 ): 212 – 219 . 10.1302/0301-620X.102B2.BJJ-2019-0692.R2 32009435
Ahmad SS , Hoos L , Perka C , Stöckle U , Braun KF , Konrads C . Follow-up definitions in clinical orthopaedic research: a systematic review . Bone Jt Open . 2021 ; 2 ( 5 ): 344 – 350 . 10.1302/2633-1462.25.BJO-2021-0007.R1 34044582
Dingemans SA , Birnie MFN , Sanders FRK , et al. Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial) . BMC Musculoskelet Disord . 2018 ; 19 ( 1 ): 35 . 10.1186/s12891-018-1946-5 29386053
Baker SP , O’Neill B , Haddon W , Long WB . The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J . ; 14 : 187 – 196 . n.d. 10.1097/00005373-197403000-00001
van den Akker-Scheek I , Seldentuis A , Reininga IHF , Stevens M . Reliability and validity of the Dutch version of the Foot and Ankle Outcome Score (FAOS) . BMC Musculoskelet Disord . 2013 ; 14 : 183 . 10.1186/1471-2474-14-183 23758917
EuroQol Group . EuroQol--a new facility for the measurement of health-related quality of life . Health Policy . 1990 ; 16 ( 3 ): 199 – 208 . 10.1016/0168-8510(90)90421-9 10109801
Penning D , Kleipool S , van Dieren S , Dingemans SM , RODEO Collaborator Group , Schepers T . The minimal clinically important difference (MCID) of the Olerud Molander Ankle Score (OMAS) in patients with unstable ankle fracture . Arch Orthop Trauma Surg . 2023 ; 143 ( 6 ): 3103 – 3110 . 10.1007/s00402-022-04533-y 35821429
Wang S , Li B , Yu X , Wu H , Liu L . Is ankle arthrodesis with an Ilizarov external fixator an effective treatment for septic ankle arthritis? a study with a minimum of six years of follow-up . Clin Orthop Relat Res . 2023 ; 481 ( 4 ): 717 – 725 . 10.1097/CORR.0000000000002418 36136051
Chan HY , Chen JY , Zainul-Abidin S , Ying H , Koo K , Rikhraj IS . Minimal clinically important differences for American Orthopaedic Foot & Ankle Society score in hallux valgus surgery . Foot Ankle Int . 2017 ; 38 ( 5 ): 551 – 557 . 10.1177/1071100716688724 28193121
Gausden EB , Levack A , Nwachukwu BU , Sin D , Wellman DS , Lorich DG . Computerized adaptive testing for patient-reported outcomes in ankle fracture surgery . Foot Ankle Int . 2018 ; 39 ( 10 ): 1192 – 1198 . 10.1177/1071100718782487 29972033
Desai S , Peterson AC , Wing K , et al. Minimally important difference in the foot and ankle outcome score among patients undergoing hallux valgus surgery . Foot Ankle Int . 2019 ; 40 ( 6 ): 694 – 701 . 10.1177/1071100719831392 30873859
Herdman M , Gudex C , Lloyd A , et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) . Qual Life Res . 2011 ; 20 ( 10 ): 1727 – 1736 . 10.1007/s11136-011-9903-x 21479777
No authors listed . Castor Electronic Data Capture . 2022 . https://www.castoredc.com/electronic-data-capture-system/ ( date last accessed 11 December 2023 ).
Desouky O , Elseby A , Ghalab AH . Removal of syndesmotic screw after fixation in ankle fractures: a systematic review . Cureus . 2021 ; 13 ( 6 ): e15435 . 10.7759/cureus.15435 34104613
Walley KC , Hofmann KJ , Velasco BT , Kwon JY . Removal of hardware after syndesmotic screw fixation: a systematic literature review . Foot Ankle Spec . 2017 ; 10 ( 3 ): 252 – 257 . 10.1177/1938640016685153 28027655
Sierevelt IN , Zwiers R , Schats W , et al. Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review . Knee Surg Sports Traumatol Arthrosc . 2018 ; 26 ( 7 ): 2059 – 2073 . 10.1007/s00167-017-4748-7 29026933
van den Akker-Scheek I , Seldentuis A , Reininga IHF , Stevens M . Reliability and validity of the Dutch version of the Foot and Ankle Outcome Score (FAOS) . BMC Musculoskelet Disord . 2013 ; 14 : 183 . 10.1186/1471-2474-14-183 23758917
Tapaninaho K , Uimonen MM , Saarinen AJ , Repo JP . Minimal important change for Foot and Ankle Outcome Score (FAOS) . Foot Ankle Surg . 2022 ; 28 ( 1 ): 44 – 48 . 10.1016/j.fas.2021.01.009 33541758
Sierevelt IN , Beimers L , van Bergen CJA , Haverkamp D , Terwee CB , Kerkhoffs G . Validation of the Dutch language version of the Foot and Ankle Outcome Score . Knee Surg Sports Traumatol Arthrosc . 2015 ; 23 ( 8 ): 2413 – 2419 . 10.1007/s00167-014-3017-2 24792074
Penning D , Jonker CAL , Buijsman R , Halm JA , Schepers T . Minifragment plating of the fibula in unstable ankle fractures . Arch Orthop Trauma Surg . 2023 ; 143 ( 3 ): 1499 – 1504 . 10.1007/s00402-022-04397-2 35224664
Penning D , Sanders FRK , van Dieren S , et al. Cost-effectiveness of on-demand removal of syndesmotic screws . Eur J Trauma Emerg Surg . 2023 ; 49 ( 2 ): 921 – 928 . 10.1007/s00068-022-02158-9 36372813
Needleman RL , Skrade DA , Stiehl JB . Effect of the syndesmotic screw on ankle motion . Foot Ankle . 1989 ; 10 ( 1 ): 17 – 24 . 10.1177/107110078901000104 2767562
Huang C-T , Huang P-J , Lu C-C , Shih C-L , Cheng Y-M , Chen S-J . Syndesmosis changes before and after syndesmotic screw removal: a retrospective radiographic study . Medicina (Kaunas) . 2022 ; 58 ( 3 ): 445 . 10.3390/medicina58030445 35334621
Boyle MJ , Gao R , Frampton CMA , Coleman B . Removal of the syndesmotic screw after the surgical treatment of a fracture of the ankle in adult patients does not affect one-year outcomes: a randomised controlled trial . Bone Joint J . 2014 ; 96-B ( 12 ): 1699 – 1705 . 10.1302/0301-620X.96B12.34258 25452376
Sanders FRK , Birnie MFN , Penning D , Goslings JC , Schepers T . Surgical site infections after routine syndesmotic screw removal: a systematic review . J Orthop Trauma . 2021 ; 35 ( 4 ): e116 – e125 . 10.1097/BOT.0000000000001954 32890071
Schepers T , Van Lieshout EMM , de Vries MR , Van der Elst M . Complications of syndesmotic screw removal . Foot Ankle Int . 2011 ; 32 ( 11 ): 1040 – 1044 . 10.3113/FAI.2011.1040 22338952
Andersen MR , Frihagen F , Madsen JE , Figved W . High complication rate after syndesmotic screw removal . Injury . 2015 ; 46 ( 11 ): 2283 – 2287 . 10.1016/j.injury.2015.08.021 26319204
Hamid N , Loeffler BJ , Braddy W , Kellam JF , Cohen BE , Bosse MJ . Outcome after fixation of ankle fractures with an injury to the syndesmosis: the effect of the syndesmosis screw . J Bone Joint Surg Br . 2009 ; 91 ( 8 ): 1069 – 1073 . 10.1302/0301-620X.91B8.22430 19651836
Verhage SM , Schipper IB , Hoogendoorn JM . Long-term functional and radiographic outcomes in 243 operated ankle fractures . J Foot Ankle Res . 2015 ; 8 : 45 . 10.1186/s13047-015-0098-1 26309448
Manjoo A , Sanders DW , Tieszer C , MacLeod MD . Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal . J Orthop Trauma . 2010 ; 24 ( 1 ): 2 – 6 . 10.1097/BOT.0b013e3181a9f7a5 20035170