Is it necessary to remove syndesmotic screw before weight-bearing ambulation?

In syndesmosis injury, whether the syndesmosis screw should be removed prior to weight-bearing remains controversial. The aim of this study was to compare the functional outcome between removed screw and retained groups and between recurrence of diastasis and no diastasis groups. Fifty-six patients who had undergone open reduction and internal fixation due to syndesmosis injury were retrospectively evaluated and divided into four groups: (A) removed syndesmotic screw before weight-bearing (postoperative 3 months, n = 28), (B)retained (n = 28), (C) recurrence of diastasis (n = 9), and (D) no diastasis (n = 47). Radiological diastasis, American Orthopedic Foot Ankle Society Score (AOFAS), Short Form Health Survey-12 (SF-12), and complications (screw loosening and breakage) were evaluated between groups. AOFAS ankle-hindfoot score was 75.10 ± 10.40 in group A, 77.07 ± 10.60 in group B. SF-12 was 45.78 ± 5.68 in group A and 47.33 ± 5.83 in group B, showing no significant difference in AOFAS ankle-hindfoot score or SF-12 (P = .487, P = .319, respectively) between groups A and B. Radiological diastasis developed significantly (P = .025) more in group A (8/28) compared to that in group B (1/28). However, screw loosening or breakage developed significantly (P = .001) more in group B (4/28) compared to that in group A (0/28). AOFAS ankle-hindfoot score was 70.33 ± 6.22 in group C and 76.50 ± 10.26 in group D. SF-12 was 49.85 ± 3.83 in group C and 47.40 ± 8.01 in group D, showing no significant difference between groups C and D in AOFAS ankle-hindfoot score or SF-12 (P = .808, P = .948, respectively). Removal of syndesmotic screw before weight-bearing does not influence clinical outcomes. Although unrelated to clinical progress, recurrence of diastasis significantly increased in screw removed group. Therefore, removal of syndesmotic screw is unnecessary before weight-bearing.