Importance Suture-button devices gained popularity for fixation of acute syndesmotic injuries, but screw fixation remains the gold standard for treatment. It is not clear if these devices are superior or at least as effective in the treatment of such injuries.
Objective This review aims to determine if current evidence supports the use of suture-button devices instead of screws in the treatment of acute syndesmotic injuries and what advantages they may bring.
Evidence review All studies comparing screw with suture-button fixation in acute syndesmotic injuries and reporting imaging parameters of maintenance of reduction, functional outcomes, complications and/or reintervention rates were selected. Cochrane Review Library,Turning Research Into Practice, Medline, PubMed, Web of Knowledge, ScienceDirect, Google Scholar and Ovid databases were searched for dates up to, and including, September 2017. Relevance was screened by title and abstract. Secondary review from the references of the selected articles was performed. Risk of bias was assessed with the Cochrane Library checklists. Data on complications, reoperations, and clinical and imaging outcomes were extracted.
Findings Suture-button devices are a valid alternative to stabilise acute syndesmosis injuries and may provide many advantages; there is a consistent trend to better clinical outcomes and significantly higher postoperative mobility, earlier weight-bearing and return to work, more accurate anatomical reduction, and decreased risk of loss of reduction.
Conclusions and relevance Suture-button devices are at least as effective as screws for fixation of acute syndesmotic injuries.
Level of evidence Level II.
- repair / reconstruction
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Contributors JFFBV provided substantial contributions to the following parts: conception and design of the work, and acquisition, analysis and interpretation of data; drafted the work; consented to the final approval of the version published; and provided an agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DRM provided substantial contributions to the following parts: acquisition and analysis of data; revising it critically for important intellectual content; and consented to the final approval of the version published. MJRS provided substantial contributions to the following parts: acquisition and analysis of data; revising it critically for important intellectual content; and consented to the final approval of the version published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; externally peer reviewed.
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