Screw versus suture button in treatment of syndesmosis instability: Comparison using weightbearing CT scan

Elghazy, Mohamed Abdelaziz; Hagemeijer, Noortje; Guss, Daniel; El-Hawary, Ahmed; Johnson, Anne H.; El-Mowafi, Hani; DiGiovanni, Christopher W.

doi:10.1016/j.fas.2021.01.001

Cited by 11 publications

(3 citation statements)

References 25 publications

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“…This finding was confirmed regardless of the type of device used, the decision to retain or remove the screw and the length of follow‐up (shorter or longer than 12 months) [17]. Conversely, while Shimozono et al and Grassi et al reported a reduced risk of joint malreduction after the use of suture button (RR 0.15 and 0.36, respectively), a recent weight‐bearing computed tomography analysis comparing 20 patients treated with syndesmotic screw stabilisation to 20 patients treated with suture button stabilisation showed that both treatments were unable to reproduce the contralateral syndesmotic area and that use of the suture button was associated with external rotation of the fibula [15]. Interestingly, in a subgroup analysis where Grassi et al considered only ‘clinically relevant complications’ (i.e.…”

Section: Discussionmentioning

confidence: 99%

Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses

Marasco

Russo

Izzo

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence. Methods In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions. Results Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far. ConclusionThe meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant. Level of evidence Level I.

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Section: Discussionmentioning

confidence: 99%

Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses

Marasco

Russo

Izzo

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…In contrast, Naqvi et al 10 found that suture button fixation provided significantly more accurate syndesmotic stabilization compared with screw fixation; however, patient-reported outcome measures (PROMs) showed no difference between the 2 groups. Additionally, Elghazy et al 8 demonstrated that external malrotation of the fibula was associated with suture button fixation but not syndesmotic screw fixation. Thus, it remains unclear which fixation approach—if either—is superior clinically.…”

Section: Discussionmentioning

confidence: 99%

“…This is despite limited and mixed evidence of clinical differences attributable to variations in implant choice. [8][9][10] In this study of patients with isolated ankle fractures undergoing open reduction, internal fixation (ORIF), we aimed to (1) calculate the mean revenue, direct costs, indirect costs, hardware costs, and contribution margin; (2) determine whether hardware costs are associated with the surgeon providing care or AO/ OTA ankle fracture classification; and (3) establish what types of hardware in ankle fracture surgical fixation are higher cost in today's health care landscape.…”

mentioning

confidence: 99%

Lack of Surgeon Standardization on Implant Selection in Ankle Fracture Fixation May Increase Costs and Decrease Contribution Margin

Bernstein

Hanna

Merchan

et al. 2021

Foot & Ankle Specialist

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Background Surgical standardization has been shown to decrease costs without impacting quality; however, there is limited literature on this subject regarding ankle fracture fixation. Methods. Between October 5, 2015 and September 27, 2017, a total of 168 patients with isolated ankle fractures who underwent open reduction, internal fixation (ORIF) were analyzed. Financial data were analyzed across ankle fracture classification type, implant characteristics, and surgeons. Bivariate analyses were conducted. One-way analysis of variance was used to compare hardware costs across all 5 surgeons. Linear regression analysis was used to determine if hardware cost differed by surgeon when accounting for fracture type. Results The mean contribution margin was $4853 (SD $6446). There was a significant difference in implant costs by surgeon (range, lowest-cost surgeon: $471 [SD $283] to $1609 [SD $819]; P < .001). There was no difference in the use of a suture button or locking plate by fracture type (P = .13); however, the cost of the implant was significantly higher if a suture button or locking plate was used ($1014 [SD $666] vs $338 [SD $176]; P < .001). There was an association between surgeon 3 (β = 200.32 [95% CI 6.18-394.47]; P = .043) and surgeon 4 (β = 1131.07 [95% CI 906.84-1355.30]; P < .001) and higher hardware costs. Conclusions Even for the same ankle fracture type, a wide variation in implant costs exists. The lack of standardization among surgeons accounted for a nearly 3.5-fold difference, on average, between the lowest- and highest-cost surgeons, negatively affecting contribution margin. Levels of Evidence Level IV

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