Hybrid, Suture Button, and Screw Fixation for Syndesmotic Stabilization in Isolated Danis Weber Type B and C Fibular Fractures

Background: Syndesmotic fixation in ankle fractures remains controversial. Hybrid fixation combines a suture button device and a syndesmotic screw, but comparative evidence remains limited. This study compared hybrid, suture button (SB), and screw fixation in isolated Danis Weber type B or C fibular fractures requiring syndesmotic stabilization. Methods: This single-center retrospective cohort study evaluated 90 patients. Groups were Hybrid (n = 28), SB (n = 31), and Screw (n = 31). The primary endpoint was 6-month Olerud Molander Ankle Score (OMAS). Secondary outcomes included visual analog scale (VAS) score, serial OMAS values, 12-month ankle range of motion (ROM), radiographic measurements, and complications. Results: Six-month OMAS did not differ significantly among groups (Hybrid 82.32 ± 7.51, SB 79.35 ± 9.29, Screw 77.10 ± 8.24, P = .091). Plain radiographic measurements were similar throughout follow-up. At 12 months, operated to intact ROM percentage was higher in the SB group than in the Screw group (82.69% ± 9.77% vs 79.54% ± 7.71%, adjusted P = .049). The difference was small, approximately 3.15 percentage points, corresponding to 2.68° of operated-side total ROM. Complication rates remained similar, including and excluding screw breakage ( P = .495 and P = .361). Conclusion: Hybrid fixation was not associated with significantly higher 6-month OMAS compared with SB or screw fixation. Because this study was powered for a large effect and was not designed for noninferiority or equivalence, smaller group differences cannot be excluded. The proportion of patients achieving the OMAS MCID threshold was higher in the Hybrid group (85.7%) than in the SB and Screw groups (both 32.3%), reflecting larger within-group score improvement from 12 weeks to 6 months rather than differences in absolute 6-month scores; the clinical significance of this finding is uncertain. The small ROM percentage difference favoring SB over screw fixation was hypothesis generating and of uncertain clinical relevance. These findings suggest that hybrid fixation is a clinically usable option, but future prospective studies should clarify whether combined dynamic and static stabilization offers added value in selected fracture patterns, instability profiles, or patient subgroups. Level of Evidence: Level III, retrospective cohort study.