JB & JS open access
Suture-Button Fixation Provides a Statistically But Not Clinically Important Improvement in Function for Syndesmotic Injuries in Unstable Ankle Fractures: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
By Hoskins W, Gusho C, Horner K and 1 others.
Abstract
Background
No consensus exists on the optimal syndesmotic fixation for unstable ankle fractures. We compared strategies using a network meta-analysis (NMA) of randomized controlled trials (RCTs).
Methods
Seven databases and trial registers were searched through November 1, 2025 for RCTs of adults undergoing fixation of an ankle fracture with syndesmotic injury; quasirandomized and duplicate/follow-up reports were excluded. Interventions were grouped a priori as suture-button/dynamic fixation, metallic 3-cortex screw (reference), metallic 4-cortex screw, bioabsorbable screw, and no fixation. A frequentist random-effects NMA estimated mean differences (MD) for function (Olerud-Molander Ankle Score [OMAS] at 1 year, the outcome reported by the most trials; AOFAS) and odds ratios (OR) for malreduction and reoperation (primary definition excluding planned implant removal), with treatments ranked by P-score and effects interpreted against the minimal clinically important difference (MCID). Certainty was rated with a CINeMA-equivalent assessment.