Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic...

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.

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.

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.

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 I.