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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury

Authors: Pei Zhang, Yuan Liang, Jinshan He, Yongchao Fang, Pengtao Chen, Jingcheng Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Now, using a suture-button device to treat distal tibiofibular syndesmotic injuries is overwhelming due to its advantages over screw fixation. Current systematic review was conducted to make a comparison between suture-button fixation and traditionally screw fixation in the treatment of syndesmotic injuries. The outcomes included functional outcomes, implant removal, implant failure, malreduction, post-operative complications (except implant failure and malreduction), and cost-effectiveness aspects.

Method

A literature search in the electronic databases of Medline, Embase, the Cochrane Library, Web of Science was conducted to identify studies until March 2017. The references of the included articles were also checked for potentially relevant studies. Only English articles were included. We followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review.

Results

Finally, 10 studies were identified, encompassing a total of 390 patients. The mean American Orthopaedic Foot and Ankle Society ankle score (AOFAS) score of 150 patients treated with the suture-button device was 91.06 points, with an average follow-up of 17.58 months, and the mean AOFAS score of 150 patients treated with syndesmotic screws was 87.78 points, with an average follow-up of 17.73 months. Implant removal was reported in 5 of 134 (3.7%) patients treated with the suture-button device, and in 54 of 134 (40.2%) patients treated with the syndesmotic screw. No patient in the suture-button fixation group had implant failure, however the rate of implant failure in the screw fixation group was 30.9%. Malreduction was reported in 1 of 93 (1.0%) patients treated with the suture-button device, and in 12 of 95 (12.6%) patients treated with the syndesmotic screw. The rate of post-operative complications in the suture-button fixation group was 12.0% and 16.4% in the screw fixation group. There was only one publication demonstrated about cost-effectiveness aspects, it showed that patients treated with the suture-button device spent on average $1482 less and had a higher quality of life by 0.058 quality-adjusted life-year compared with patients who received fixation with 2 syndesmotic screws in supination-external rotation type 4 injuries.

Conclusion

Based on our research, though the suture-button fixation group had similar functional outcome (measured on the AOFAS score) and post-operative complication rate compared with the syndesmotic screw fixation group, the suture-button device could lead to better objective range of motion (ROM) measurements and earlier return to work. Besides, the suture-button fixation group had lower rate of implant removal, implant failure, and malreduction. However, high-quality randomized controlled trials with more uniformity in outcome reporting are desirable to determine the long-term effects and cost-effectiveness of the suture-button device.
Literature
1.
Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br. 2008;90(4):405–10.CrossRefPubMed
2.
Kim JH, Gwak HC, Lee CR, Choo HJ, Kim JG, Kim DY. A comparison of screw fixation and suture-button fixation in a Syndesmosis injury in an ankle fracture. J Foot Ankle Surg. 2016;55(5):985–90.CrossRefPubMed
3.
Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36(6):1199–206.CrossRefPubMedPubMedCentral
4.
Kocadal O, Yucel M, Pepe M, Aksahin E, Aktekin CN. Evaluation of reduction accuracy of suture-button and screw fixation techniques for Syndesmotic injuries. Foot Ankle Int. 2016;37(12):1317–25.CrossRefPubMed
5.
Schepers T, Van Lieshout EM, Hj VDL, De Jong VM, Goslings JC. Aftercare following syndesmotic screw placement: a systematic review. J Foot Ankle Surg. 2013;52(4):491–4.CrossRefPubMed
6.
Mp VDB, Kloen P, Luitse JS, Raaymakers EL. Complications of distal tibiofibular syndesmotic screw stabilization: analysis of 236 patients. J Foot Ankle Surg. 2013;52(4):456–9.CrossRef
7.
Magan A, Golano P, Maffulli N, Khanduja V. Evaluation and management of injuries of the tibiofibular syndesmosis. Br Med Bull2014;111(1):101-115.
8.
Kortekangas T, Savola O, Flinkkila T, Lepojarvi S, Nortunen S, Ohtonen P, et al. A prospective randomized study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury. 2015;46(6):1119–26.CrossRefPubMed
9.
Laflamme M, Belzile EL, Bédard L, Van Den Bekerom MPJ, Glazebrook M, Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015;29(5):216–23.CrossRefPubMed
10.
Xu G, Chen W, Zhang Q, Wang J, Su Y, Zhang Y. Flexible fixation of syndesmotic diastasis using the assembled bolt-tightrope system. Scand J Trauma Resusc Emerg Med. 2013;21(1):71.CrossRefPubMedPubMedCentral
11.
Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle Syndesmotic injuries comparison of TightRope fixation and Syndesmotic screw fixation for accuracy of Syndesmotic reduction. Am J Sports Med. 2012;40(12):2828–35.CrossRefPubMed
12.
Cottom JM, Hyer CF, Philbin TM, Berlet GC. Transosseous fixation of the distal Tibiofibular Syndesmosis: comparison of an Interosseous suture and Endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620–30.CrossRefPubMed
13.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712.CrossRefPubMed
14.
Coetzee JC, Ebeling P. Treatment of syndesmosis disruptions with TightRope fixation. Tech Foot Ankle Surg. 2008;7(3):196–202.CrossRef
15.
Coetzee JC, Ebeling P. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs TightRope® fiber wire fixation—medium term results. SA Orthop J. 2009;8:32–7.
16.
Neary KC, Mormino MA, Wang HM. Suture button fixation versus syndesmotic screws in Supination-external rotation type 4 injuries: a cost-effectiveness analysis. Am J Sports Med. 2017;45(1):210–7.CrossRefPubMed
17.
Seyhan M, Donmez F, Mahirogullari M, Cakmak S, Mutlu S, Guler O. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury. 2015;46:S19–23.CrossRefPubMed
18.
Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431:207–12.CrossRef
19.
Andersen MR, Frihagen F, Madsen JE, Figved W. High complication rate after syndesmotic screw removal. Injury. 2015;46(11):2283–7.CrossRefPubMed
20.
Lalli TA, Matthews LJ, Hanselman AE, Hubbard DF, Bramer MA, Santrock RD. Economic impact of syndesmosis hardware removal. Foot. 2015;25(3):131.CrossRef
21.
Hsu YT, Wu CC, Lee WC, Fan KF, Tseng I, Lee PC. Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function. Int Orthop. 2011;35(4):625.CrossRefPubMedCentral
22.
Schepers T, Van Lieshout EM, de Vries MR, Van der Elst M. Complications of syndesmotic screw removal. Foot Ankle Int. 2011;32(11):1040–4.CrossRefPubMed
23.
Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg. 2011;131(7):879–83.CrossRefPubMed
24.
Manjoo A, Sanders DW, Tieszer C, Macleod MD. Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Orthop Trauma. 2010;24(1):2–6.CrossRefPubMed
25.
Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification. Injury. 2012;43(6):838–42.CrossRefPubMed
26.
Cottom JM, Hyer CF, Philbin TM, Berlet GC. Treatment of syndesmotic disruptions with the Arthrex tightrope: a report of 25 cases. Foot Ankle Int. 2008;29(8):773.CrossRefPubMed
27.
Rigby RB, Cottom JM. Does the Arthrex TightRope®; provide maintenance of the distal Tibiofibular SYNDESMOSIS? A 2-year follow-up of 64 TightRopes®; in 37 patients. J Foot Ankle Surg. 2013;52(5):563.CrossRefPubMed
28.
Treon K, Beastall JE, Kumar K, Hope MJ. Complications of ankle syndesmosis stabilization using a tightrope. Plant Cell Physiol. 2011;40(11):1309–12.
29.
Anand A, Wei R, Patel A, Vedi V, Allardice G, Anand BS. Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicenter case series. Eur J Orthop Surg Traumatol. 2017;27(4):461–7.CrossRefPubMed
30.
Hodgson P, Thomas R. Avoiding suture knot prominence with suture button along distal fibula: technical tip. Foot Ankle Int. 2011;32(9):908–9.CrossRefPubMed
31.
Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32(3):250–6.CrossRefPubMed
32.
Fantry AJ, O'Donnell SW, Born CT, Hayda RA. Deep infections after Syndesmotic fixation with a suture button device. Orthopedics. 2017;40(3):e541–5.CrossRefPubMed
33.
Inge SY, ter Gunne AFP, Aarts CAM, Bemelman M. A systematic review on dynamic versus static distal tibiofibular fixation. Injury. 2016;47(12):2627–34.CrossRefPubMed
34.
Summers HD, Sinclair MK, Stover MD. A reliable method for intraoperative evaluation of syndesmotic reduction. J Orthop Trauma. 2013;27(4):196–200.CrossRefPubMed
35.
Mukhopadhyay S, Metcalfe A, Guha AR, Mohanty K, Hemmadi S, Lyons K, et al. Malreduction of syndesmosis--are we considering the anatomical variation? Injury. 2011;42(10):1073–6.CrossRefPubMed
36.
Rammelt S, Obruba P. An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg. 2015;41(6):601–14.CrossRefPubMed
37.
Franke J, Recum JV, Suda AJ, Grützner P, Wendl K, Bone J. Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am. 2012;20(6):190–1.
38.
Thornes B, McCartan D. Ankle Syndesmosis injuries treated with the TightRopeTM suture-button kit. Tech Foot Ankle Surg. 2006;5(1):45–53.CrossRef
Metadata
Title
A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury
Authors
Pei Zhang
Yuan Liang
Jinshan He
Yongchao Fang
Pengtao Chen
Jingcheng Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1645-7

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