Different Treatment Methods for Syndesmotic Ankle Fractures: A Cost and Complication Meta-analysis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Syndesmotic ankle fractures are serious injuries that can lead to pain and chronic instability. Surgical treatments include screw fixation, suture button fixation, and fibular nailing. This meta-analysis seeks to explore the differences in costs and complications between these three treatment methods. Methods: Literature review was conducted on PubMed and Embase up until December 2024. Comparison studies that investigated at least two of the treatment methods and reported a cost analysis with or without complication metrics were included in this study. Review Manager 5.4. was used for statistical analyses, and a P-value ≤ 0.05 was considered statistically significant. Results: Nine studies were ultimately included, with a total of 2,440 patients. When comparing suture button to screw fixation, there was a statistically significant difference in initial implant cost in favor of screw fixation. When comparing screw fixation to fibular nail, there was a significant difference in final cost in favor of fibular nail. When comparing suture button to fibular nail, there was a significant difference in final cost in favor of suture button fixation. When comparing suture button to screw fixation, there was a significant difference in overall complication rate and in reoperation rate in favor of suture button fixation. When comparing suture button to fibular nail, there was a significant difference in overall complication rate and infection rate in favor of suture button fixation. Conclusion: Suture button fixation appears to be the preferable treatment method in regard to both complication outcomes and overall treatment costs, with the fibular nail technique being an effective alternative regarding cost. Further studies reporting costs and pertinent complication metrics should be performed in order to provide a clearer picture of the differences between surgical techniques for syndesmotic ankle fractures.