A Prospective, Randomized Suture-button vs Screw Syndesmotic Fixation

Abstract

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Syndesmotic disruption occurs in 10 to 13% of all ankle fractures. It is present in 15 cases per 100,000 of the general population. There has been debate on the best treatment for syndesmotic injuries. The typical surgical treatments include fixation with either screws or suture button devices. The purpose of this study is to compare clinical outcomes of syndesmotic injuries treated surgically with either screws or suture button devices. It was hypothesized that suture button fixation would provide equal clinical results with less need for hardware removal. Methods: This was a multi-center, randomized, prospective clinical trial comparing two surgical interventions for treatment of acute syndesmotic injury. At the time of surgical intervention, subjects were placed into either the screw fixation or the Suture-button device group by opening a randomized envelope in the operating room. Subjects with clinical signs or radiographic evidence of syndesmotic injury were asked to participate in this study. Inclusion criteria was ages 18 to 65 years old with confirmed syndesmotic instability. The primary outcomes of thestudy were VAS scores (activity, pain, satisfaction) and FFI scores (pain, disability, activity) which were collected at preoperative state, 6 weeks, and 12 months postoperatively. Results: Sixty-five subjects were enrolled in this study. Thirty-two subjects received Suture-button fixation (49%) and 33 received screw fixation (51%). VAS scores and FFI scores for subjects treated with the Suture-button device or screw fixation comparing preoperative, six-week, and 12-month scores all showed clinical improvement. There was no significant difference between the two treatment groups (p >0.05). Nine subjects (27%) in the syndesmotic screw fixation group experienced adverse events; four required repeat surgery for symptomatic syndesmotic screw removal, one for revision fixation, and four did not return to surgery despite hardware failure. One subject(3%) in the suture-button group required hardware removal. Conclusion: The short-term clinical outcomes suggest that both syndesmotic screws and suture-button devices are effective treatment options to address acute syndesmotic injuries. In the short-term (12-months), suture-button fixation resulted in significantly less adverse events compared to syndesmotic screw fixation group.

Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials

“…1,32 We included the study that gave us more information and had the lower risk of bias. 32 Furthermore, we identified 1 more RCT by citation search 5 and by search of Google Scholar, 14 leaving a total of 8 RCTs for inclusion in final meta-analysis. 5,6,14,21,22,31,32,34…”

“…32 Furthermore, we identified 1 more RCT by citation search 5 and by search of Google Scholar, 14 leaving a total of 8 RCTs for inclusion in final meta-analysis. 5,6,14,21,22,31,32,34…”

“…Four of 8 RCTs did not report SD. 5,14,31,32 All studies were published in English language. The follow-up period ranged from 12 to 60 months.…”

“…One study of 8 was an anonymized RCT with a level I evidence 6 ; the other 7 studies were non anonymized RCTs with level II evidence. 5,14,21,22,31,32,34 Functional Outcomes AOFAS AOFAS score <6 months postoperatively. Data on 399 patients (including 195 patients with SB and 204 patients with SF) were pooled from 5 RCTs.…”

“…30,39 Although some meta-analyses on this topic are available, some do not provide reliable results and others followed poor statistical methods. 4,[10][11][12]14,26,29,36,[45][46][47] The specialist literature still has room for high-quality studies on this subject. We formulated the following PICO (population, intervention, control, and outcomes) question: In human participants in acute syndesmotic diastasis injury, is the SB technique superior compared with the SS technique in functional outcome and complications?…”