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

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.