Dynamic Fixation Versus Static Fixation for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Abstract

Background Ankle sprains with distal tibiofibular syndesmosis injuries (DTSIs) require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint. In the last decade, dynamic fixation (DF) for DTSIs using a suture-button device has gained popularity because of its advantages over static fixation (SF). Material/Methods The present meta-analysis was conducted to compare clinical outcomes between DF and SF of DTSIs. PubMed, Cochrane Central Register of Controlled Trials, and Embase were systematically searched. Three randomized controlled studies and 7 cohort studies, with a total of 420 patients, were involved in this study. DTSIs patients treated with DF were assigned to the experimental group, and patients treated with SF were assigned to the control group. Outcomes were evaluated and analyzed by using review-manager software. Mean difference (MD) or risk ratio (RR) with 95% confidence interval (95% CI) was analyzed and calculated by utilizing the random effects models. Results Analysis revealed no statistically significant differences between DF and SF in American Orthopedic Foot and Ankle Society Ankle-Hindfoot score (MD, 1.90; 95% CI, −0.23–4.03; p =0.08; I 2 =0%), Olerud-Molander score (MD, 1.92; 95% CI, −7.96–11.81; p =0.70; I 2 =55%), incidence of syndesmotic malreduction (RR, 0.19; 95% CI, 0.03–1.09; p =0.06; I 2 =0%), and overall postoperative complication rate (RR, 0.30; 95% CI, 0.09–0.99; p =0.05, I 2 =75%). The rate of second procedure was significantly lower compared with DF (RR, 0.17; 95% CI, 0.07–0.43; p =0.0002, I 2 =54%). Conclusions The dynamic fixation and static fixation methods are equal in clinical outcomes, with dynamic fixation needing fewer second interventions for DTSIs.

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

“…When comparing the non-RCT meta-analyses, 4,10,12,26,45,46,47 it is again noticeable that several of them included exactly the same studies, namely, the 2019 meta-analysis by Fan et al 10 and the 2019 meta-analysis by Gan et al, 12 or almost the same studies, namely, the 2019 meta-analysis by Chen et al 4 and the 2017 meta-analysis by Zhang et al 47 The 2019 meta-analysis by McKenzie et al 26 had a very small sample size considering that it was not limited to RCTs. Considering good scientific practice, some of these meta-analyses were unnecessary to publish.…”

Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury

“…[ 15 ] In addition, a meta-analysis by Gan et al has reported that dynamic fixation using suture-button fixation results in similar clinical outcomes for the treatment of distal tibiofibular syndesmosis injury compared with static fixation using screw fixation but is associated with a reduced requirement for secondary intervention. [ 39 ] In this study, we used tendon suture fixation for the treatment of distal tibiofibular syndesmosis injury and found that, in comparison with screw fixation, tendon suture fixation was associated with a similar clinical outcome at 6 months after surgery, but quicker ankle function recovery and reduced ankle pain at 3 months after surgery.…”

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

“…During the last decades, several studies have clearly shown superior results after flexible dynamic syndesmotic stabilization compared to the use of syndesmotic screws with regard to accuracy of reduction, functional outcome, and even development of posttraumatic ankle arthritis [9,29,32,34,48,49,55,57,69,71,72,76,83,94,102,111,115,124,125,129,130,132,138,171]. Seven of these comparisons were randomized controlled trials [9,32,34,72,76,111,124].…”