DOS 2017

110

· DOS Abstracts

A Systematic Review and Meta-analysis of treatment

of Ankle Fractures with Syndesmotic Rupture; Suture-

Button Fixation vs. Cortical Screw Fixation

Alexandra Claire McKenzie, Kristian Eskild Hesselholt,

Orthopedic surgery, Odense University Hospital; Orthopedic surgery, Odense

University Hospital; ,

Background:

Ankle fractures accompanied by syndesmotic rupture are a com-

plex challenge for orthopedic surgeons. Sufficient reduction and stabilization of

the syndesmosis is important to prevent early degeneration of the ankle joint

and to optimize clinical outcomes.

Purpose / Aim of Study:

To systematically review the literature comparing

the suture-button fixation method to the cortical screw fixation method when

treating syndesmotic rupture.

Materials and Methods:

A systematic review of the literature including Co-

chrane, Pubmed and Embase was performed. Following search terms were used:

ankle fractures, syndesmosis rupture, tibiofibular syndesmosis injury, ankle joint,

tightrope and suture button. Inclusion criteria were comparison studies, acute

ankle fractures with syndesmotic rupture, adult patients and Coleman score

>60. Cadaveric studies, chronic instability, open fractures, polytraumas and

arthropathies were excluded. Two investigators independently reviewed titles

and relevant abstracts. Reoperation and malreduction rate were compared in a

meta- analysis.

Findings / Results:

Six studies with 275 patients were included: Two RCT’s,

two prospective and two retrospective cohort studies. All studies used similar

surgical techniques. Functional outcomes (AOFAS & OM) were not quantitative

comparable. No significant less number of malreduction events were detected

in the suture- button group (RR=0.19, (95% CI, 0.03;1.04) P=0.06). Signifi-

cant lower reoperation rate was detected in the suture-button group (RR=0.21,

(95% CI, 0.06;0.69) P=0.01).

Conclusions:

The suture-button technique showed significant lower reopera-

tion rate and tendency towards less malreduction and better AOFAS scores. This

finding is clinical relevant, however, this conclusion is primarily based on two

studies, and therefore, the issue demands further research.

No conflicts of interest reported

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