Syndesmosis screws: how many, what diameter, where and should they be removed? A literature review

Although screw fixation remains the most commonly used method of syndesmosis fixation, the ideal screw size, placement, and number remain controversial. In addition, there has been debate as to whether the screw should always be removed, and a number of studies have looked at radiological and functional outcomes. In addition a number of cadaveric models have been developed, but the correlation between cadaveric findings and functional outcomes remains unclear. This systematic review of the literature aims to summarise the available evidence on how many screws should be placed, of what diameter, through how many cortices, at what level, and whether they should be removed.