Suture Button versus Screw Fixation for Distal Tibiofibular Injury and Expected Value Decision Analysis.

Autor:	Schulte SS; Orthopaedics, William Beaumont Army Medical Center, El Paso, USA., Oplinger SL; F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA., Graver HR; Orthopaedics, William Beaumont Army Medical Center, El Paso, USA., Bockelman KJ; Orthopaedics, William Beaumont Army Medical Center, El Paso, USA., Frost LS; Orthopaedics, William Beaumont Army Medical Center, El Paso, USA., Orr JD; Orthopaedics, William Beaumont Army Medical Center, El Paso, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2021 Nov 25; Vol. 13 (11), pp. e19890. Date of Electronic Publication: 2021 Nov 25 (Print Publication: 2021).
DOI:	10.7759/cureus.19890
Abstrakt:	Patient preference for fixation technique of syndesmotic injury in the presence of an ankle fracture is not known. This study followed a five-step process for expected value decision analysis: decision tree, outcome probabilities, expected patient values, foldback analysis, and sensitivity analysis. Outcome variables were "well" (cases that did not require further procedures or suffer any complications related to surgery), surgical site infection (SSI), loss of reduction (LOR), hardware removal (HWR), and malreduction. The systematic review included 22 studies including 358 patients who underwent suture button fixation and 739 who underwent screw fixation. Outcome probabilities for suture button fixation were 76.4% well, 6.2% SSI, 5.4% LOR, 10.4% HWR, and 1.6% malreduction. Outcome probabilities for screw fixation were 47.1% well, 4.3% SSI, 8.1% LOR, 30.7% HWR, and 9.8% malreduction. After the survey and foldback analysis, overall utility values for suture button and screw fixation were 7.46 and 4.78, respectively. One-way sensitivity analysis revealed that the overall utility value for suture button fixation was greater than the utility value of screw fixation under all circumstances except when the rate of malreduction for suture button fixation was theoretically elevated to 85%. Level of evidence: therapeutic, level IV. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2021, Schulte et al.)
Databáze:	MEDLINE
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