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

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

doi:10.1016/j.fas.2018.11.008

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

Foot Ankle Surg. 2020 Jan;26(1):54-60. doi: 10.1016/j.fas.2018.11.008. Epub 2018 Nov 22.

Authors

James Randolph Onggo¹, Mithun Nambiar², Kevin Phan³, Benjamin Hickey⁴, Anuruthran Ambikaipalan⁵, Raphael Hau⁶, Harvinder Bedi⁷

Affiliations

¹ Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. Electronic address: jamesonggo1993@hotmail.com.
² Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: mithunnambiar1@gmail.com.
³ The Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, The Prince of Wales Private Hospital, Sydney, New South Wales, Australia. Electronic address: kphan.vc@gmail.com.
⁴ Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. Electronic address: drhickey@hotmail.co.uk.
⁵ Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. Electronic address: rudyambi@gmail.com.
⁶ Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Monash University, Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia. Electronic address: raphaelhau@hotmail.com.
⁷ Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. Electronic address: hsbedi1@bigpond.com.

PMID: 30503612
DOI: 10.1016/j.fas.2018.11.008

Abstract

Background: Ankle syndesmotic injuries can be surgically managed with syndesmosis screws (SS) or suture button (SB) fixation. We performed a meta-analysis of randomized controlled trials (RCTs) aiming to compare the clinical and complication profiles of both modalities.

Methods: A multi-database search up to 4th of March 2018 was performed according to PRISMA guidelines. All RCTs comparing both techniques and published in English were included.

Results: Five RCTs with a total of 280 patients (140 SB, 140 SS) were included for analysis. SB had a statistically significant higher AOFAS score at 1 year (mean difference=5.46, 95% CI=0.40-10.51, p=0.03) and lower implant failure rate (OR=0.03, 95% CI=0.01-0.15, p<0.001). Infection and wound issues were marginally higher with SB (OR=1.4, 95% CI=0.4-4.85, p=0.60). No other parameters showed statistically significant difference.

Conclusions: Both constructs yielded similar clinical outcomes. The 1 year AOFAS score was higher in SB but clinical significance is unlikely. SB had significantly fewer implant failures.

Level of evidence: Level I.

Keywords: Ankle; Diastasis; Screw; Suture button; Syndesmosis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Ankle Injuries / surgery*
Ankle Joint / surgery*
Bone Screws*
Fracture Fixation, Internal / methods*
Humans
Randomized Controlled Trials as Topic
Suture Techniques*
Sutures*