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Erschienen in: International Orthopaedics 9/2013

01.09.2013 | Review Article

Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis

verfasst von: Chen Wang, Xin Ma, Xu Wang, Jiazhang Huang, Chao Zhang, Li Chen

Erschienen in: International Orthopaedics | Ausgabe 9/2013

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Abstract

No consensus had been reached about the optimal method for syndesmotic fixation. The present study analysed syndesmotic fixation based on the highest level of clinical evidence in order to obtain more reliable results. Medline, Embase and Cochrane database were searched through the OVID retrieval engine. Manual searching was undertaken afterward to identify additional studies. Only randomized controlled trials (RCT) and prospective comparative studies were selected for final inclusion. Study screening and data extraction were completed independently by two reviewers. All study characteristics were summarized into a table. The extracted data were used for data analysis. Twelve studies were finally included: six of them were RCTs, two were quasi-randomized studies and four were prospective comparative studies. Four comparisons with traditional metallic screw were identified in terms of bioabsorbable screws, tricortical fixation method, suture-button device as well as non-fixation choice in low syndesmotic injuries. Both absorbable screws and the tricortical fixation method showed almost no better results than traditional quadricortical metallic screw (p > 0.05). Additionally, existing studies could not illustrate their efficiency of reducing hardware removal rate. The suture button technique had significantly better functional score (p = 0.003), ankle motion (p = 0.02), time to full weightbearing (p < 0.0001) and much less complications (p = 0.0008) based on short and intermediate term follow-up data. Transfixation in low syndesmotic injuries showed poorer results than the non fixed group in all outcome measurements, but didn’t reach a significant level (p > 0.05). The present evidence still couldn’t find superior performance of the bioabsorbable screw and tricortical fixation method. Their true effects in decreasing second operation rate need further specific studies. Better results of the suture-button made it a promising technique, but it still needs long-term testing and cost-efficiency studies. The patients with low syndemotic injuries should be well assessed before fixation determination and the indication of screw placement in such conditions needs to be further defined.
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Metadaten
Titel
Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis
verfasst von
Chen Wang
Xin Ma
Xu Wang
Jiazhang Huang
Chao Zhang
Li Chen
Publikationsdatum
01.09.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 9/2013
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1999-x

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