A systematic review on dynamic versus static distal tibiofibular fixation.

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomaterials Engineering

Background:

• Dynamic fixation, particularly suture-button techniques, is gaining traction for syndesmotic injuries due to perceived advantages over static fixation.
• This systematic review evaluates suture-button fixation against traditional static fixation for unstable ankle fractures with distal tibiofibular syndesmosis injury.

Purpose of the Study:

• To compare the functional outcomes, complication rates, reoperation rates, recurrent diastasis, and financial aspects of dynamic (suture-button) versus static fixation.
• To assess the efficacy of suture-button devices in stabilizing ruptured syndesmosis.

Main Methods:

• A systematic literature search was performed on PubMed/MEDLINE and EMBASE from January 2006 to February 2016.
• Included studies comprised 4 on suture-button fixation, 5 comparing suture-button to static fixation, and 1 on financial aspects.
• Level of Evidence: 1A (Economic/Decision Analysis).

Main Results:

• Patients treated with suture-button devices (n=104) achieved an average AOFAS score of 91.08 (follow-up: 24.85 months).
• Patients treated with static fixation (n=106) had an average AOFAS score of 87.95 (follow-up: 24.78 months).
• Device removal rates were 10.5% for suture-buttons versus 38.5% for static fixation screws.

Conclusions:

• Dynamic fixation with suture-button devices is a viable alternative for stabilizing syndesmotic injuries.
• This method demonstrates lower reoperation rates and fewer complications compared to static fixation.
• Suture-button devices effectively stabilize ruptured syndesmosis without device failure or loss of reduction.