['Arthroscopic ankle arthrodesis (AAA) is a recognised salvage procedure for end-stage arthritis. Its reported disadvantages include a high rate of re-operation for symptomatic prominence of metalwork. We propose that the use of a headless screw would reduce this re-operation rate.', 'We reviewed 32 AAAs, using the Acutrak™6/7 mm headless screw fixation system, to determine peri-operative parameters and complication rates.', 'At an average of 22 months follow-up, 28 (88%) had united radiologically. There were 2 stable fibrous non-unions not requiring further intervention. Of the other 2, one was successfully revised using an open technique, and the other patient died of unrelated causes. There were no other complications in this series, with no cases of metalwork removal for prominence or pain.'] Does headless compression screw fixation prevent symptomatic metalwork in arthroscopic ankle arthrodesis?