Remove or Retain Syndesmotic Screw?

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Hello Everyone!

I broke/dislocated my right ankle, as well as stretched out ligaments completely, on 12/2. Surgery was performed on 12/13 and as of my last check up yesterday, 1/22, doctor says my fractures look pretty much completely healed. However, I still have to wait an additional 6 weeks for the ligaments to continue to heal, so I am still not weight bearing.

Dr. says that it is up to me as to whether I want to undergo surgery again to get the syndesmotic screw (how i understand it, it is a big screw connecting the tib/fib so that the syndesmotic ligament is not used) removed. He says there is not a big difference between patients who keep the screw, and patients who have it removed. He says that in time by walking on the ankle, the screw will loosen on its own and maybe even eventually break, which will allow me to regain more dorisflexion. However, if I was to just get it removed, the dorisflexion would return much sooner.

My research shows that he is generally right, there is not that much of a difference between those who take the screw out and those who keep it. I guess it really depends on whether you want to undergo surgery again so soon or not. 

Have any of you faced a similar decision on your road to recovery? What did you choose and why? Any help/input is greatly appreciated!

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12 Replies

  • Posted

    I wish I could help you make your decision however I noticed I broke my ankle just two days before you. Broke both the tib and fib. I could see the larger bone beneath my skin the foot hanging off to the side lamely. 

    Good for you for doing research what a decision to make! I have 8 screws two in one side the rest in the other. The two on the inside are bothersome. I would not want to have surgery again. I’m not fully healed from the first.

    Feel free to write back. It is depressing and lonely sitting on the bed. 

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    • Posted

      Hi Alison!

      I’m so sorry to hear that you also suffered a similar injury around the same time😔. If you also stretched out your ligaments, do you also have the syndesmotic screw across your tib/fib?

      Are you weight bearing yet? How is your recovery going so far? 

      And yes! Very lonely indeed.

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    • Posted

      No I guess I did not stretch out my ligaments. I had read about that but whenever I see my doc I forget to ask that but it has not been an issue. No I never heard of that screw. My screws are 6 on one side and two on the other. As far as I know they are in no way connected. The six have their own plate and the other two are on their own. They bother me though. My take away from this other forum I was reading is don’t mess with them unless they bother you. However, some people say they have increased range of motion when they are removed. But most of those people had issues with them before they were removed.
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    • Posted

      Oh , I am weight bearing a bit. I have a knee scooter and do fall off it on certain terrain. On those occasions I have put a lot of weight on my foot. The foot tolerates it, but then it inflamed and I get muscle spasms. My recovery is going OK but got off to a bad start cause the original dr. Was less than stellar. He used staples instead if stitches and I was allergic to some kind of anti-microbial wash he used so I had blisters. I still have scabs and now, mentally, I’m starting to get down. How about you?
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    • Posted

      Good Morning Alison!

      Hmm, yeah I guess you did not damage your ligaments too much thank goodness! And that's great that you are able to use a knee scooter, although falling off and putting weight on the leg is prob very uncomfortable/scary. Have you gone back for the 6 week check up to see if the fractures have healed yet?

      I also bought a knee scooter but had a lot of issues with pain in the knee so I returned it. I was so excited to get it so I could start to cook and do things around the house but it was just too uncomfortable. 

      Staples sound awful for incisions like that in my opinion. I have (luckily) never had staples or stitches before this injury, but I would assume stitches allow the incisions to heal cleaner than staples. An allergic reaction on top of it all sounds so painful sad I'm so sorry you had to go through that. I still have scabs too, but at PT today they told me that was the blood underneath pushing up and out of the body into blood blisters and that its normal. It is funny what the word "normal" has turned into during this process, lol.

      How is your range of motion? Do you go to PT, too?

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    • Posted

      Hi! Yes I did go to my 6 week check up two weeks ago everything looked fine. But you are right about the staples. They just do not heal cleanly. So internally I’m doing better than externally. I will start PT next week. I just had too much swelling this past week. I have ok range of motion so far. My foot gets purple and patchy white

      looking especially in the shower. 

      Even with the scooter I cannot do much. It’s great for shopping but for cooking I’m too low and it requires adept balance at all times. Just got to wait it out!!! Little by little every day is a bit better. How are you doing?

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    • Posted

      Wow I really can't believe that first doctor went with staples! I am also surprised they did not start you on PT sooner, I have been going since 3.5 weeks after surgery for ROM. Although, if there is anything that I have learned about this its that everyone has a different experience and it seems there is a lot of controversy involving best practices with doctors (ex: staples vs. stitches, boot vs. hard cast, etc.).

      I also can't believe you're doing your own shopping! You are brave lol. I have been relying on my boyfriend for stuff like that (he has been godsend during this whole thing, I am so beyond lucky/grateful). 

      And I am doing okay today, had PT at 7am today and since I told them the bones are all healed on xrays they were a little extra aggressive with stretching so I am feeling it at the moment lol. Other than that I am doing alright though, if only a little bit bored home alone again but such is life while we are NWB. I suppose it is better than having too much to do and being unable to do it, you know? Hope you're feeling alright today, too!

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    • Posted

      What did you do at PT? Did you swell up? Yeah, everyone is so different! I had a bad fracture, that’s all the first dr. said. I go to PT on Monday. The scooter gets you out on any surface that’s level. So going into stores is easy. My husband is doing all the cooking and cleaning, laundry, etc. Falling off the scooter isn’t as bad as it sounds because it’s so low you basically roll off. It’s getting up! A Little Rock, piece of mulch or crack in the sidewalk can do you in! Getting back up is what hurts. People offer outstretched hands but I have to remember to get up on my own. I can’t drive bc it’s my right foot so I can’t go shopping on my own. I go to just get out. Also use the walker to get outside.
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  • Posted

    Forum_F1/Pros_and_Cons_of

    Hi, I came across this discussion, it might not address your particular screw type, but it seems to be worth the read regarding retaining or removing screws, plates, etc. Alison

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  • Posted

    Yes I removed the screw 

    Completely shattered ankle and had plate screws on both sides- syndemosis screw attached in the middle. I had syndemosis screw taken out- did not alter anything- and basically 1/2 a day recovery- easy...

    BUT

    I ENDED UP WITH AN INFECTION A COUPLE OF MONTHS LATER IN HOSPITAL WITH IV ANTIBIOTICS FOR SEVERAL DAYS... then I needed to get surgery to get half of hardware out- had to go through long recovery again - and continuous rounds of oral antibiotics and just starting PT AGAIN...

    I personally would not touch hardware unless there is a problem..

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    • Posted

      Hi Marge,

      Thank you for reaching out and sharing your experience. I am so sorry you had to go through an extended uncomfortable/painful process afterwards due to the complications. It seems like it is very easy for anything to complicate the injury and healing process in these situations! I hope you are on the mend nowadays. 

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    • Posted

      Sorry that happened, that sounds horrible!!! Hope you are feeling better and never break anything again!!
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