Z Orthop Unfall 2014; 152(6): 554-557
DOI: 10.1055/s-0034-1382934
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Ist das routinemäßige Belassen von Syndesmosenschrauben nach operativer Versorgung instabiler Sprunggelenksfrakturen gerechtfertigt? Erfahrung eines US-Traumazentrums an 140 konsekutiven Patienten

Is the Standard Retention of Syndesmotic Positioning Screws after Ankle Fracture Fixation Safe and Feasible? A Retrospective Cohort Study in 140 Consecutive Patients at a North American Trauma Centre
S. Weckbach
1   Department of Orthopaedics, Denver Health Medical Center, Denver, Colorado, United States
,
J. Hahnhaussen
1   Department of Orthopaedics, Denver Health Medical Center, Denver, Colorado, United States
,
J. T. Losacco
1   Department of Orthopaedics, Denver Health Medical Center, Denver, Colorado, United States
,
F. Gebhard
2   Klinik für Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm
,
P. F. Stahel
1   Department of Orthopaedics, Denver Health Medical Center, Denver, Colorado, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
22 December 2014 (online)

Zusammenfassung

Hintergrund: Instabile Sprunggelenksfrakturen mit Verletzung der Syndesmose werden i. d. R. durch temporäre transfixierende Stellschrauben versorgt. Die weit verbreitete Auffassung, dass Stellschrauben nach Verheilen der Syndesmosenverletzung elektiv entfernt werden sollen, bleibt kontrovers und entbehrt einer wissenschaftlichen Grundlage. Die vorliegende Studie wurde konzipiert, um die Hypothese zu testen, dass das Belassen von Syndesmosenstellschrauben bei asymptomatischen Patienten gerechtfertigt ist. Patienten und Methoden: Retrospektive Analyse eines 5-Jahres-Zeitraums einer prospektiven Datenbank aller operativ versorgter Sprunggelenksfrakturen in einem repräsentativen akademischen Level-1-Traumazentrum der USA. Alle in diesem Zeitraum operativ versorgten Frakturen des oberen Sprunggelenks wurden in die Analyse eingeschlossen. Der Endpunkt der Studie war die Rate der elektiven Syndesmosenschraubenentfernungen innerhalb von 6 Monaten nach operativer Versorgung. Ergebnisse: In dem 5-Jahres-Zeitraum der Studie wurden 496 konsekutive Patienten mit 496 isolierten, osteosynthetisch versorgten Sprunggelenksfrakturen eingeschlossen. Davon wurden 140 Verletzungen mit Stellschraube(n) versorgt. Radiologisch waren 17,1 % aller Stellschrauben innerhalb von 6 Monaten gebrochen und 13,6 % der Syndesmosenschrauben wiesen radiologische Lockerungszeichen auf. Lediglich in 2 Fällen (1,4 %) wurden Syndesmosenschrauben wegen subjektiver Symptomatik entfernt. Schlussfolgerung: Trotz der hohen Rate des radiologischen Versagens von Syndesmosenstellschrauben in beinahe einem Drittel aller Fälle, benötigen mehr als 98 % aller Patienten keine elektive Stellschraubenentfernung. Die routinemäßige Entfernung von Syndesmosenstellschrauben scheint deshalb bei asymptomatischen Patienten nicht gerechtfertigt zu sein.

Abstract

Background: Unstable ankle injuries with associated disruption of the distal-fibular syndesmosis are typically managed by adjunctive placement of temporary syndesmotic positioning screws. The widespread notion that positioning screws must be removed by default after healing of the syndesmosis remains a topic of debate which lacks scientific support. The present study was designed to test the hypothesis that syndesmotic positioning screws are safely retained per protocol in asymptomatic patients. Patients and Methods: A retrospective analysis of an institutional prospective database was performed during a 5-year time-window at an academic level 1 trauma centre in the United States. All ankle fractures requiring surgical fixation were included in the analysis. The primary outcome parameter consisted of the rate of elective hardware removal for syndesmotic positioning screws within 6 months after surgical fixation. Results: A total of 496 consecutive patients with 496 isolated ankle fractures managed by surgical fixation were included in this study. Of these, 140 injuries were managed by placement of syndesmotic positioning screws. Within 6 months follow-up, 17.1 % of all syndesmotic screws were found to be radiographically broken, and 13.6 % of syndesmotic screws revealed radiographic signs of loosening. Only 2 patients (1.4 %) required the elective removal of symptomatic positioning screws within 6 months of surgical fracture fixation. Conclusion: Despite the high rate of radiographic complications related to breaking or loosening of syndesmotic screws in almost one third of all cases, more than 98 % of all patients remain asymptomatic and do not require a scheduled hardware removal. The routine removal of syndesmotic positioning screws does not appear to be justified from a patient safety perspective.

 
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