Surgical site infections following routine syndesmotic screw removal; a systematic review.

OBJECTIVES Aim of this systematic review is to investigate the incidence of surgical site infections (SSIs) after routine removal of syndesmotic screws (SSs) placed to stabilize syndesmotic injuries. DATA SOURCES A systematic literature search was performed in the PubMed, Cochrane, and EMBASE databases for studies published online before February 2020, using the key words and synonyms of "syndesmotic screw" and ("ankle fractures" or "syndesmotic injury") and "implant removal". STUDY SELECTION Studies were eligible for inclusion when they described >10 adult patients undergoing elective/scheduled removal of the SS. DATA EXTRACTION The 15 included articles were assessed for quality and risk of bias using the Newcastle-Ottawa Scale. Baseline characteristics of the studies, the study population, the intervention, potential confounders and primary outcome (% of SSIs) were extracted using a customized extraction sheet. DATA SYNTHESIS The primary outcome was presented as a proportion of included patients and as a weighted mean, using inverse variance, calculated in RStudio. Furthermore, potential confounders were identified. CONCLUSIONS The percentage of SSIs ranged from 0 to 9.2%, with a weighted mean of 4%. The largest proportion of these infections were superficial (3%, 95%CI: 2-5), compared to 2% deep infections (95%CI: 1-4). These rates were comparable to those of other foot/ankle procedures indicating that the individual indication for SS removal should be carefully considered. Future studies should focus on valid indications for SSR, the influence of prophylactic antibiotics on SSI after SSR, and complications of retaining the syndesmotic screw to enable a fair benefits/risks comparison of routine vs. on-demand removal of the SS.