Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials

Onggo, James Randolph; Nambiar, Mithun; Phan, Kevin; Hickey, Benjamin; Ambikaipalan, Anuruthran; Hau, Raphael; Bedi, Harvinder S.

doi:10.1016/j.fas.2018.11.008

Cited by 30 publications

(40 citation statements)

References 29 publications

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“…However, only 1 patient (7%) in the syndesmosis group required a second procedure and there were no failures of fixation or delayed widening of the syndesmosis in this group. Onggo et al, 8 in their 2018 meta-analysis comparing methods of syndesmotic fixation, report an overall reoperation rate of 18.6% (52/279) and a wound infection rate of 3.5% (10/279) for combined syndesmotic screw and suture button constructs across 5 studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

et al. 2019

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Background: There is a growing trend toward early weightbearing as tolerated (WBAT) after open reduction and internal fixation (ORIF) of ankle fractures. To date, studies have excluded fractures with associated syndesmotic injuries from their cohorts. Methods: In this retrospective cohort study, a chart review was performed at a single level 1 trauma center, identifying all unstable ankle fractures that underwent operative fixation between July 2016 and July 2017. After exclusion criteria, 63 patients were identified and 31 were included in the final analysis, with 14 undergoing syndesmotic fixation. WBAT was initiated after suture removal, between 2 and 4 weeks postoperatively. Outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, and the need for repeat surgery. Results: Weightbearing was initiated at an average of 17.8 days. All 31 patients progressed toward fracture union, with no hardware failures. Three patients developed superficial wound breakdown, which was treated with protected weightbearing in all cases and oral antibiotics in 1 case. All 3 went on to heal from their incisions. One patient had delayed wound breakdown and required a split-thickness skin graft that subsequently healed without complication. One patient underwent hardware removal 6 months postoperatively. There were no revision ORIF procedures. Conclusion: There is literature supporting early WBAT after ORIF of unstable ankle fractures in patients without major comorbidities. This article supports this trend, demonstrating that a group of ankle fractures requiring syndesmotic fixation were included in the early weightbearing cohort without a higher rate of catastrophic failure or increased wound problems. Level of Evidence Level IV, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

et al. 2019

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“…However, the authors concluded that this difference was unlikely to be clinically meaningful and found no statistically significant differences for any other parameters examined. 45…”

Section: Dynamic Syndesmotic Fixationmentioning

confidence: 99%

“…However, the authors concluded that this difference was unlikely to be clinically meaningful and found no statistically significant differences for any other parameters examined. 45 There have also been several cost analyses comparing suture button fixation to standard syndesmotic fixation. Neary et al 42 assumed a 20% rate of syndesmotic screw removal and a 4% rate of suture button removal and found the total cost of syndesmotic screw fixation to be $1482 greater than suture button fixation given a suture button cost of $880.…”

Section: Dynamic Syndesmotic Fixationmentioning

confidence: 99%

Advances in the Surgical Management of Ankle Fractures

Wright

Bariteau

Hsu

2019

Foot & Ankle Orthopaedics

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Ankle fractures are one of the most common injuries treated by orthopedic surgeons worldwide. However, operative indications, techniques, and reported outcomes following operative fixation vary widely in the literature. This evidence-based review focuses on recent advances in the operative management of ankle fractures including arthroscopic-assisted surgery, deltoid ligament complex repair, expanded indications for posterior malleolus fixation, fibula intramedullary nailing, and dynamic syndesmosis repair. Level of Evidence: Level V, expert opinion.

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“…Over time, with the improvement in technology, new materials have been proposed in clinical practice, with the introduction of pre-assembled constructs made up of two No, 5 polyester sutures and two titanium or stainless steel endobuttons [29].Upon review of the literature, multiple randomised controlled trials (RCTs) compared traditional static vs. more recently introduced dynamic strategies of fixation for the TFS [2,9,10,22,23,25,35]. Additionally, several meta-analyses have been published [7,16,17,28,32], often suggesting that the dynamic fixation could be superior to static fixation in terms of clinical outcome and complication rates. However, the results of such studies are not always in agreement, and to the best of our knowledge, their quality has never been assessed so far.…”

Section: Introductionmentioning

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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Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials

Cited by 30 publications

References 29 publications

Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

Advances in the Surgical Management of Ankle Fractures

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

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