SLR - January 2019 - Lenny Nguyen

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-Analysis of Randomized Controlled Trials

Reference: Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-Analysis of Randomized Controlled Trials. The American Journal of Sports Medicine. 2018 Nov 26.

Scientific Literature Review

Reviewed By: Lenny Nguyen, DPM
Residency Program: NYU Langone Hospital, Brooklyn, NY

Podiatric Relevance: Surgical correction is indicated for unstable syndesmotic injuries. Up to 20 percent of all ankle fractures require syndesmotic surgical correction. The most commonly used method of fixation is a syndesmotic screw, although a new fixation of a suture button was created to address some of the concerns with using a syndesmotic screw. There is no consensus on the recommended form of fixation. The purpose of the paper was to perform a meta-analysis of randomized controlled trials evaluating syndesmotic screw and suture button based off clinical outcomes.

Methods: Using PRISMA guidelines, a literature search was performed to find randomized controlled trials comparing suture buttons and syndesmotic screws. The studies must have been published in peer-review journals, and cadaver studies were excluded. The level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Clinical outcomes of interest were the American Orthopaedic Foot and Ankle Society (AOFAS) score, joint malreduction, implant failure, implant removal and total number of complications.

Results: Five clinical studies were identified for the meta-analysis. This allowed 285 total patients to be compared, with 143 in the suture button group and 142 in the syndesmotic screw group. Patients who had syndesmotic injuries fixated with suture buttons had a higher postoperative AOFAS score at a mean of 20.8 months. The suture button group also had a 0.8 percent rate of joint malreduction compared to the 11.5 percent of the syndesmotic screw group. For implant failure, the suture button group had a rate of 0 percent compared to 25.4 percent in the other group. Also, the suture button group had a 6 percent implant removal rate against a 22.4 percent rate of the syndesmotic screw patients.

Conclusions: Based off of the meta-analysis, patients who receive a suture button fixation had a lower rate of malreduction, implant failure and implant removal. The suture button group also had better functional outcomes. This study recommended suture button fixation for syndesmotic injuries. This study is helpful to podiatric physicians because it compares two common methods for surgical syndesmotic repair, while showing a possible preferred method of fixation.

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