Yoshiharu Shimozono1,2,3, Eoghan T Hurley1,4, C Lucas Myerson1,5, Christopher D Murawski6, John G Kennedy1. 1. Hospital for Special Surgery, New York, New York, USA. 2. Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan. 3. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Royal College of Surgeons in Ireland, Dublin, Ireland. 5. School of Medicine, Tulane University, New Orleans, Louisiana, USA. 6. School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract
BACKGROUND: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries. PURPOSE: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. STUDY DESIGN: Meta-analysis. METHODS: A literature search was performed according to the PRISMA guidelines to identify randomized controlled trials comparing the SB and SS techniques for syndesmosis injuries. Level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Statistical analysis was performed with RevMan, and a P value ≤.05 was considered statistically significant. RESULTS: Five clinical studies were identified, allowing comparison of 143 patients in the SB group with 142 patients in the SS group. Patients treated with the SB technique had a higher postoperative American Orthopaedic Foot & Ankle Society score at a mean 20.8 months (95.3 vs 86.7, P < .001). The SB group resulted in a lower rate of broken implants (0.0% vs 25.4%, P < .001), implant removal (6.0% vs 22.4%, P = .01), and joint malreduction (0.8% vs 11.5%, P = .05) as compared with the SS group. CONCLUSION: The SB technique results in improved functional outcomes as well as lower rates of broken implant and joint malreduction. Based on the findings of this meta-analysis, the SB technique warrants a grade A recommendation by comparison with the SS technique for the treatment of syndesmosis injuries.
BACKGROUND: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries. PURPOSE: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. STUDY DESIGN: Meta-analysis. METHODS: A literature search was performed according to the PRISMA guidelines to identify randomized controlled trials comparing the SB and SS techniques for syndesmosis injuries. Level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Statistical analysis was performed with RevMan, and a P value ≤.05 was considered statistically significant. RESULTS: Five clinical studies were identified, allowing comparison of 143 patients in the SB group with 142 patients in the SS group. Patients treated with the SB technique had a higher postoperative American Orthopaedic Foot & Ankle Society score at a mean 20.8 months (95.3 vs 86.7, P < .001). The SB group resulted in a lower rate of broken implants (0.0% vs 25.4%, P < .001), implant removal (6.0% vs 22.4%, P = .01), and joint malreduction (0.8% vs 11.5%, P = .05) as compared with the SS group. CONCLUSION: The SB technique results in improved functional outcomes as well as lower rates of broken implant and joint malreduction. Based on the findings of this meta-analysis, the SB technique warrants a grade A recommendation by comparison with the SS technique for the treatment of syndesmosis injuries.
Authors: Manuel Mutschler; Jan-Hendrik Naendrup; Thomas R Pfeiffer; Vera Jaecker; Dariusch Arbab; Sven Shafizadeh; Tomas Buchhorn Journal: Arch Orthop Trauma Surg Date: 2022-04-11 Impact factor: 3.067
Authors: Robert Hennings; Carolin Fuchs; Ulrich J Spiegl; Jan Theopold; Firas Souleiman; Christian Kleber; Annette B Ahrberg Journal: Int Orthop Date: 2022-08-19 Impact factor: 3.479