title: A systematic review on dynamic versus static distal tibiofibular fixation.
abstract: BACKGROUND
  In the last couple of years dynamic fixation for syndesmosis injuries, using a suture-button technique, raised more interest due to its advantages over the static fixation. In the current systematic review suture-button fixation is compared to the traditionally applied static fixation in unstable ankle fractures accompanied with distal tibiofibular syndesmosis injury, including the functional outcome, post-operative complications, reoperation rate, recurrent diastasis and financial aspects.
  
  
  METHODS
  A computerized literature search using PubMed/MEDLINE and EMBASE was conducted in search of suitable articles between January 2006 and February 2016. A total of 4 suture-button studies, 5 suture-button vs. static fixation studies and 1 study discussing the financial aspects were identified.
  
  
  RESULTS
  The AOFAS of 104 patients treated with the suture-button device was 91.08 points with an average study-follow up of 24.85 months. The AOFAS of 106 patients treated with a static fixation device was 87.95 with an average follow-up of 24.78 months. Removal of the suture-button device was reported in 10.5% of 229 patients and removal of the screws in 38.5%.
  
  
  CONCLUSIONS
  Dynamic fixation demonstrated to be a viable alternative to the static fixation device, with lower reoperation rates and less complications. They can accurately stabilize the ruptured syndesmosis without device breakage or loss of reduction.
  
  
  METHODS
  1A economic/decision.
authors: Dept. of Surgery, Elisabeth - Tweesteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. Electronic address: sy.inge@gmail.com.
authors: S Y
authors: SY
authors: Inge
authors: Dept. of Surgery, Elisabeth - Tweesteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. Electronic address: a.pulltergunne@etz.nl.
authors: A F
authors: AF
authors: Pull Ter Gunne
authors: Dept. of Surgery, Elisabeth - Tweesteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. Electronic address: cam.aarts@etz.nl.
authors: C A M
authors: CAM
authors: Aarts
authors: Dept. of Surgery, Elisabeth - Tweesteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. Electronic address: m.bemelman@etz.nl.
authors: M
authors: M
authors: Bemelman
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005360:Fibula; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability; D008023:Ligaments, Articular / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D053441:Suture Anchors; D013536:Suture Techniques / Q000295:instrumentation*; D013977:Tibia; D016896:Treatment Outcome
keywords: Ankle injury; Static fixation; Suture-button; Syndesmosis injury