Bimalleolar fracture and Syndesmotic injury - broken syndesmotic screw; should it be removed?

Hello,

I sustained a Bimalleolar Fracture with a Syndesmotic injury to my left ankle after a rough skydiving landing in July 2010. I have a metal plate and 6 scres on the outer side of my anke, plus two pins on the inner side of my ankle. I also have a syndesmosis screw(spelling??) Through the middle. My initial surgeon advised me to get the syndesmosis (long) screw out before I broke it. Unfortunately my insurance would not allow the initial surgeon to complete the surgery thus I had to wait an extended time for a new referral and by that time the screw had broken. I tried to keep it in, but pain increased. Now I am looking at going back and the surgeon is advising to take out all of the hardware except the broken part of the screw. The screw broke very near it's "head", so there will still be a very long piece through the middle. The doctor stated he would try to to take the broken part out also, if I absolutely wanted to.

I've heard that the bone could fuse to screw but still cause problems later. I've also heard that the screw will continue to break in other places if left in and I resume my active lifestyle. Then I've also heard its riskier to take it out, because the doctor has to core a hole through the bone bigger than the screw to be able to remove it, and there could be issues with healing and bone strength after.

Anyone have thoughs on this? I am trying to decide if I want them to try and get the broken piece out also, or leave that long piece in.

Thanks,
Christine

Hi Christine,
This is one of those issues where there is no clear answer. Since the head of the syndesmotic screw is broken, it makes it more difficult to remove but not impossible but because it has to be bored out, it will require a larger hole and there is always issues with the large hole such as fracture of the tibia or fibula.
If you are going to bother to got back in and have surgery, removing the other hardware is not a bad idea, depending on how much hardware there is there because in many instances over time that hardware as well can become an issue.
I think your best move, even if you have to pay out of pocket, would be to get a second opinion from someone who can actually look at the xrays and be in a better position to totally assess the situation.
Marc Mitnick DPM