{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:10:21Z","timestamp":1792192221792,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T00:00:00Z","timestamp":1669680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Ankle fractures are often combined with syndesmotic instability, requiring reduction and stabilization. However, the optimal level for syndesmotic screw positioning remains unclear. This study aims to evaluate the effect of different syndesmotic screw insertion levels on postoperative clinical outcomes and determine whether an optimal level exists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included data from 43 adult patients with acute closed ankle fractures combined with intraoperative evidence of unstable syndesmotic injuries who underwent open reduction internal fixation from January 1, 2017 to March 1, 2018 according to the inclusion and exclusion criteria. All 43 patients were divided into three groups based on the syndesmotic screw placement level: trans\u2010syndesmotic group: screw level of 2\u20133\u00a0cm; inferior\u2010syndesmotic group: screw level &lt;2\u00a0cm; and supra\u2010syndesmotic group: screw level &gt;3\u00a0cm. Clinical outcomes were measured at the final follow\u2010up, including the American Orthopedic Foot and Ankle Society (AOFAS) ankle\u2010hindfoot score, Olerud\u2013Molander Ankle Score (OMAS), short\u2010form 36\u2010item questionnaire (SF\u201036), visual analogue scale (VAS) score and restrictions in ankle range of motion (ROM). The relationships between screw placement level and clinical outcomes were analyzed with the Kruskal\u2013Wallis H\u2010test and Spearman correlation analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median follow\u2010up duration was 15\u00a0months (range, 10\u201322\u00a0months). No patients developed fracture nonunion or malunion or experienced hardware failure. The outcome scoring systems showed an overall score for the entire group of 94.91 points for the AOFAS ankle\u2010hindfoot score, 83.14 for the OMAS, 96.65 for the SF\u201036, 1.77 for the VAS, 9.14\u00b0 for the restrictions in dorsiflexion, and 1.30\u00b0 for the restrictions in plantarflexion. There were no significant differences among three groups in clinical outcomes (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05). Neither the AOFAS score nor OMAS had significant correlations with screw insertion level (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.825 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00.585, respectively). No postoperative arthritis or widening of the tibiofibular space was observed at the final follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Different syndesmotic screw placement levels appear not to affect the clinical outcomes of ankle fractures with syndesmotic instability. No optimal level was observed in this study. Our findings suggest other clinically acceptable options apart from syndesmotic screw placement 2\u20133\u00a0cm above the ankle.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13569","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T12:24:31Z","timestamp":1669724671000},"page":"247-255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9529-0025","authenticated-orcid":false,"given":"Jin\u2010Kun","family":"Li","sequence":"first","affiliation":[{"name":"Graduate School Tianjin University of Traditional Chinese Medicine  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yu","sequence":"additional","affiliation":[{"name":"Zhanjiang First Hospital of Traditional Chinese Medicine  Zhanjiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying\u2010Hua","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tianjin Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tianjin Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xian\u2010Tie","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tianjin Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-3988","authenticated-orcid":false,"given":"Jia\u2010Guo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tianjin Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001363"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2016.04.001"},{"issue":"5","key":"e_1_2_7_4_1","first-page":"558","article-title":"Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints","volume":"10","author":"Ogilvie\u2010Harris DJ","year":"1994","journal-title":"Art Ther"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2020.102778"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2011.11.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.210017"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-19-00358"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2021.09.022"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110079701800503"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3182a6df0a"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199901000-00009"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2022.01.004"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2013.09.035"},{"key":"e_1_2_7_15_1","first-page":"198","article-title":"Ankle fractures. The Lauge\u2010Hansen classification revisited","volume":"345","author":"Michelson J","year":"1997","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_7_16_1","first-page":"1","article-title":"Injuries of the upper ankle joint","volume":"3","author":"M\u00fcller ME","year":"1972","journal-title":"Aktuelle Probl Chir"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2019.05.020"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110079401500701"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00435553"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)90884-8"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2005.01.014"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-020-02476-w"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-020-03649-9"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00435946"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100718759966"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13569","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.13569","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13569","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T10:34:20Z","timestamp":1692441260000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,29]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/os.13569"],"URL":"https:\/\/doi.org\/10.1111\/os.13569","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,29]]},"assertion":[{"value":"2022-01-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}