Houston Methodist. Leading Medicine

Ankle FAQ


I have one more week before the surgeon takes the cast off my leg for a spiral-shaped fracture of the fibular bone. I also tore the ligament between the two leg bones so there are two screws holding the bones together. Should I ask them to take those screws out or do they just leave them in otherwise?


When there's enough force on the ankle to push it into external rotation while the foot is planted, a spiral-shaped fracture can occur in the upper third of the fibula. The fibula is one of two bones in the lower leg. It is the smaller bone situated on the outside or lateral side of the leg. Essentially the lower leg is externally (outwardly) rotated with the foot planted on the ground. With a traumatic injury from a fall or sports collision, the connective tissue between the two bones (tibia and fibula) can be completely torn. This is called a syndesmotic disruption. Without this strong fibrous interconnecting ligament, one bone can shift up or down in relation to the other. The shift can cause a difference in leg length from one leg to the other. That's why the surgeon puts two long screws between the tibia and the fibula at the top and bottom -- to hold them in good alignment while the fracture heals. The screws can be left in place or taken out according to the surgeon's preferences and the patient's wishes. Many surgeons prefer to leave them in unless they have come loose and/or are backing out. Performing a second surgery to remove the hardware increases the risk of infection, fracture, poor wound healing, or other surgical complications. There is no harm in leaving the screws in place. Unless they are bothering you, causing pain, or have been disrupted, it is considered best to leave them alone. Surgeons will take hardware out for patients who are concerned about potential harmful effects from leaving the screws in place. Bharati S. Kalyani, MD, et al. The Maisonneuve Injury: A Comprehensive Review. In Orthopedics. March 2010. Vol. 33. No. 3. Pp. 190-195.

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