Functional outcome of routine versus on-demand removal of the syndesmotic screw

Stein van den Heuvel; Diederick Penning; Fay Sanders; Ruben van Veen; Nico Sosef; Bart van Dijkman; Tim Schepers; RODEO Collaborator group

doi:10.1302/2633-1462.412.BJO-2023-0061

Functional outcome of routine versus on-demand removal of the syndesmotic screw

Bone Jt Open. 2023 Dec 18;4(12):957-963. doi: 10.1302/2633-1462.412.BJO-2023-0061.

Authors

Stein van den Heuvel¹, Diederick Penning¹, Fay Sanders¹, Ruben van Veen², Nico Sosef³, Bart van Dijkman⁴, Tim Schepers¹; RODEO Collaborator group

Affiliations

¹ Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands.
² Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands.
³ Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
⁴ Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands.

PMID: 38108322
PMCID: PMC10726379
DOI: 10.1302/2633-1462.412.BJO-2023-0061

Abstract

Aims: 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).

Methods: 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.

Results: 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).

Conclusion: 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.