Background: Ankle fractures are one of the most common types of fractures, comprising 18% of all skeletal injuries annually. These fractures frequently involve the distal tibiofibular syndesmosis. The syndesmosis is vital in stabilizing the ankle mortise and transmitting load during weight bearing. In this study we reviewed the literature for comparison between suture button and syndesmotic screw fixation.
Aim of the work: A Systematic review to compare between suture button and syndesmotic screw fixation in distal tibiofibular syndesmotic injuries.
Methods: This systematic review consisted of 5 RCTs, including a systematic search of literature (PubMed/medline, National Library of Medicine, and The Cochrane Library), selection of studies, extraction of study characteristics, assessment of methodological quality and bias and extraction of data on clinical outcomes and their comparisons between different surgical groups using revman 5.2.
Results: A total of 5 RCTs were included, 347 patients were extracted from the included studies. Of the 347 patients, 170 (48.991%) had undergone suture button fixation and 177 (51.008%) had undergone syndesmotic screw fixation. The minimum follow-up duration was 12 months. These procedures were done using standard AO technique. suture button group had significantly higher AOFAS score with less implant failure (before 8 weeks), malreduction rates and reoperation (not including routine screw removal), with higher rate of wound infection.
Conclusion: We concluded that the suture-button device could lead to better objective range of motion measurements and earlier return to work, besides, the suture-button fixation group had lower rate of implant removal, implant failure, and malreduction. Multicenter randomized clinical trials are needed to obtain a high-quality level of evidence for the comparison between suture button and syndesmotic screw.