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Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The present meta-analysis evaluated current level I clinical trials which compared the use of a suture button (SB) versus syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. It was hypothesised that SB might achieve better PROMs along with a lower rate of complications.

Methods

This study was conducted according to the 2020 PRISMA statement. In August 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed. All the randomised controlled trials (RCTs) which compared SB versus SS fixation for syndesmosis injuries of the ankle were accessed. Data concerning the American Orthopaedic Foot & Ankle Society (AOFAS), and Olerud-Molander score (OMS) were collected at baseline and at last follow-up. Data on implant failure, implant removal, and joint malreduction were also retrieved.

Results

Data from seven RCTs (490 patients) were collected. 33% (161 of 490) were women. The mean length of the follow-up was 30.8 ± 27.4 months. The mean age of the patients was 41.1 ± 4.1 years. Between the two groups (SB and SS), comparability was found in the mean age, and men:women ratio. The SS group evidenced lower OMS (P = 0.0006) and lower AOFAS (P = 0.03). The SS group evidenced a greater rate of implant failure (P = 0.0003), implant removal (P = 0.0005), and malreduction (P = 0.04).

Conclusion

Suture button fixation might perform better than the syndesmotic screw fixation in syndesmotic injuries of the ankle.

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Data availability

The datasets generated during and/or analysed during the current study are available throughout the manuscript.

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Authors and Affiliations

  1. Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy

    Filippo Migliorini, Federico Cocconi & Dragana Katusic

  2. Department of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy

    Nicola Maffulli

  3. School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK

    Nicola Maffulli

  4. Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK

    Nicola Maffulli

  5. Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany

    Luise Schäfer & Andreas Bell

  6. Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India

    Raju Vaishya

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Contributions

Filippo Migliorini: conception and design, statistical analyses, drafting; Nicola Maffulli: supervision, revision; Dragana Katusic: writing; Luise Schäfer: literature search, data extraction, risk of bias assessment; Federico Cocconi: literature search, data extraction, risk of bias assessment; Andreas Bell: supervision; Raju Vaishya: drafting. All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.

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Migliorini, F., Maffulli, N., Cocconi, F. et al. Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05354-x

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  • DOI: https://doi.org/10.1007/s00402-024-05354-x

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