Dynamic fixation is superior in terms of clinical outcomes to static fixation in managing distal tibiofibular syndesmosis injury

Abstract

Purpose: To analyze the current randomized controlled trials (RCTs) of dynamic fixations (DFs) and static fixations (SFs) in treating distal tibiofibular syndesmosis injuries (DTSIs).

Methods: The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE were systematically searched according to the PRISMA guidelines to identify RCTs comparing the DFs and SFs for DTSIs. Included studies were assessed using the Cochrane Risk of Bias Tool. Postoperative functional scores, range of motion (ROM), complication rate, and incidence of reoperation were statistically analyzed using review manager software, and a p value of < 0.05 was considered statistically significant.

Results: Five RCTs with a total of 282 patients were included. Analysis revealed statistically significant differences in favor of DFs with regard to American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score at a follow-up less than 6 months (MD 5.29; 95% CI 0.99-9.59; p = 0.02; I² = 0%) and at a follow-up more than 2 years (MD 7.53; 95% CI 3.30-11.76; p = 0.0005; I² = 0%), Olerud-Molander ankle (OMA) score at 1 year follow-up (MD 4.62; 95% CI 0.91-8.32; p = 0.01; I² = 14%), and overall postoperative complication rate (RR 0.22; 95% CI 0.07-0.77; p = 0.02; I² = 73%). There was no significant difference between the DFs and SFs regarding ROM and incidence of reoperation.

Conclusions: The DF procedure leads to significantly improved functional scores as well as lower rate of overall postoperative complications when compared with SF procedure. On the basis of results of this meta-analysis, the DF should be recommended for managing the DTSI.

Level of evidence: I.

Keywords: Ankle; Meta-analysis; Screw; Suture button; Syndesmosis.