title: Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis.
abstract: A meta-analysis was performed to investigate the outcomes between absorbable screw (AS) and metallic screw (MS) fixation for distal tibiofibular syndesmosis injuries (DTSIs). Randomized controlled trials comparing AS versus MS fixation in DTSIs were searched systematically, and the outcomes were analyzed using Review Manager Software, version 5.2. The risk ratio (RR) or mean difference with the 95% confidence interval (CI) was calculated using the fixed effects or random effects model. A total of 16 studies were included in the meta-analysis. No statistically significant difference was found between AS and MS fixation in excellent and good functional recovery rate (RR 1.11, 95% CI 1.00 to 1.23, I(2) = 60%, p = .06), infection (RR 1.66, 95% CI 0.73 to 3.79, I(2) = 0%, p = .23), incidence of pain (RR 0.68, 95% CI 0.24 to 1.92, I(2) = 12%, p = .47), screw broken (RR 0.31, 95% CI 0.03 to 2.93, I(2) = %, p = .31), heterotopic ossification (RR 1.93, 95% CI 0.21 to 17.62, I(2) = 51%, p = .56; 472 cases in 4 studies), fracture healing time (mean difference -1.88, 95% CI -3.51 to -0.26, I(2) = 93%, p = .02,), duration of operation time (mean difference 7.64, 95% CI -3.80 to 19.09, I(2) = 98%, p = .19). The incidence of foreign body reaction was higher with AS fixation (RR 6.07, 95% CI 2.54 to 14.50, I(2) = 0%, p < .001). The reoperation rate was higher with MS fixation (RR 0.08, 95% CI 0.03 to 0.18, I(2) = 77%, p < .01). The functional outcomes of AS were as good as those with MS for DTSIs. Other than the foreign body reaction, the complications occurring after AS fixation were not as serious as those with MS fixation. AS fixation might be a preferable alternative for reconstruction of DTSIs.
authors.affiliation: Master of Medicine, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Yuanlong
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Professor, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China. Electronic address: guke3559@aliyun.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Cai
authors.affiliation: Orthopedist, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Zhouming
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Master of Medicine, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Ran
authors.affiliation: Orthopedist, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Hu
mesh_terms: D020341:Absorbable Implants; D064386:Ankle Fractures / Q000601:surgery*; D001863:Bone Screws; D005549:Foreign-Body Reaction / Q000209:etiology; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008670:Metals; D011183:Postoperative Complications
chemical_list: D008670:Metals
keywords: absorbable screw; foreign body reaction; meta-analysis; metallic screw; reoperation; syndesmosis injuries