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Dynamic fixation is superior in terms of clinical outcomes to static fixation in managing distal tibiofibular syndesmosis injury

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyze the current randomized controlled trials (RCTs) of dynamic fixations (DFs) and static fixations (SFs) in treating distal tibiofibular syndesmosis injuries (DTSIs).

Methods

The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE were systematically searched according to the PRISMA guidelines to identify RCTs comparing the DFs and SFs for DTSIs. Included studies were assessed using the Cochrane Risk of Bias Tool. Postoperative functional scores, range of motion (ROM), complication rate, and incidence of reoperation were statistically analyzed using review manager software, and a p value of < 0.05 was considered statistically significant.

Results

Five RCTs with a total of 282 patients were included. Analysis revealed statistically significant differences in favor of DFs with regard to American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot score at a follow-up less than 6 months (MD 5.29; 95% CI 0.99–9.59; p = 0.02; I2 = 0%) and at a follow-up more than 2 years (MD 7.53; 95% CI 3.30–11.76; p = 0.0005; I2 = 0%), Olerud–Molander ankle (OMA) score at 1 year follow-up (MD 4.62; 95% CI 0.91–8.32; p = 0.01; I2 = 14%), and overall postoperative complication rate (RR 0.22; 95% CI 0.07–0.77; p = 0.02; I2 = 73%). There was no significant difference between the DFs and SFs regarding ROM and incidence of reoperation.

Conclusions

The DF procedure leads to significantly improved functional scores as well as lower rate of overall postoperative complications when compared with SF procedure. On the basis of results of this meta-analysis, the DF should be recommended for managing the DTSI.

Level of evidence

I.

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Acknowledgements

The authors thank Professor Kang Zheng, Department of Orthopaedics, Ningbo Medical Center Lihuili Hospital, Ningbo City, P.R. China, for his clinical practice recommendations.

Funding

No funding was received in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Ningbo Medical Center Lihuili Hospital, Xingning Road No. 57, Ningbo City, 315040, People’s Republic of China

    Kaifeng Gan, Keqi Hu & Yandong Shen

  2. Medical School of Ningbo University, Ningbo City, People’s Republic of China

    Kaifeng Gan & Dingli Xu

  3. Department of Orthopaedics, Second Hospital of Ningbo, Ningbo City, People’s Republic of China

    Wei Wu

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  1. Kaifeng Gan
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Correspondence to Kaifeng Gan.

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Gan, K., Xu, D., Hu, K. et al. Dynamic fixation is superior in terms of clinical outcomes to static fixation in managing distal tibiofibular syndesmosis injury. Knee Surg Sports Traumatol Arthrosc 28, 270–280 (2020). https://doi.org/10.1007/s00167-019-05659-0

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