Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

被引:58
作者
Raeder, B. W. [1 ]
Figved, W. [1 ]
Madsen, J. E. [1 ,2 ,3 ]
Frihagen, F. [1 ,2 ]
Jacobsen, S. B. [1 ,4 ]
Andersen, M. R. [1 ,5 ]
机构
[1] Vestre Viken Hosp Trust, Baerum Hosp, Dept Orthopaed Surg, Gjettum, Norway
[2] Oslo Univ Hosp, Div Orthopaed Surg, Oslo, Norway
[3] Univ Oslo, Fac Med, Inst Clin Med, Orthopaed Trauma, Oslo, Norway
[4] Oslo Univ Hosp, Dept Radiol & Nucl Med, Oslo, Norway
[5] Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway
关键词
QUALITY-OF-LIFE; TIBIOFIBULAR SYNDESMOSIS; ANKLE-HINDFOOT; FIXATION; MALREDUCTION; ACCURACY; FOOT; OSTEOARTHRITIS; TIGHTROPE; VALIDITY;
D O I
10.1302/0301-620X.102B2.BJJ-2019-0692.R2
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Aims In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. Methods A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. Results The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (-0.1 mm vs 1.2 mm; p = 0.016). Conclusion Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury.
引用
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页码:212 / 219
页数:8
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