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

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 AND 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; I²=0%), Olerud-Molander score (MD, 1.92; 95% CI, -7.96-11.81; p=0.70; I²=55%), incidence of syndesmotic malreduction (RR, 0.19; 95% CI, 0.03-1.09; p=0.06; I²=0%), and overall postoperative complication rate (RR, 0.30; 95% CI, 0.09-0.99; p=0.05, I²=75%). The rate of second procedure was significantly lower compared with DF (RR, 0.17; 95% CI, 0.07-0.43; p=0.0002, I²=54%). CONCLUSIONS The dynamic fixation and static fixation methods are equal in clinical outcomes, with dynamic fixation needing fewer second interventions for DTSIs.