March 3, 2026Open Access

Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference

Key Points

Suture button fixation shows superior functional scores, though often not exceeding minimal clinically important difference thresholds.
Key evidence indicates suture button resulted in higher functional scores compared to syndesmotic screws, but clinical relevance remains unclear.
Umbrella review analyzes multiple studies, emphasizing the need for refined MCID values in ankle-specific patient-reported outcomes.
These findings highlight ongoing uncertainty about the cost-effectiveness of suture button fixation for ankle fractures.

Abstract

While SB fixation often demonstrates superior functional scores relative to SS fixation, these differences seldom exceed established MCID thresholds. The clinical relevance of these improvements therefore remains uncertain. As routine removal of syndesmotic screws is no longer advocated in the contemporary literature, and considering the findings of the present study, one could argue that the cost-effectiveness of using a suture-button in under scrutiny. Future studies should focus on refining MCID values for ankle-specific PROMs and improving methodological rigour in systematic reviews and meta-analyses to better determine whether SB fixation provides a meaningful advantage for patients.

Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference

Key Points

Abstract

Cite This Study