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Background <p>The optimal fixation method for acute syndesmotic injuries remains controversial. With the increasing burden of healthcare expenditures, treatment decisions should also consider cost analysis. The aim of this study was to compare the clinical outcomes and cost analysis of tricortical screw, quadricortical screw, and suture-button fixation in patients with isolated lateral malleolus fractures associated with syndesmotic instability.</p> Methods <p>This retrospective cohort study included patients treated surgically between January 2022 and January 2025. Patients were retrospectively categorized into three groups according to the fixation method used. One-year postoperative Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and total treatment costs were compared. According to institutional protocol, quadricortical screws were routinely removed at postoperative week six, and removal costs were included in the total cost analysis.</p> Results <p>Seventy patients were included (Suture-button: 20; Tricortical screw: 19; Quadricortical screw: 31). No significant differences were observed among groups in terms of VAS scores or total costs (<i>p</i> = 0.73 and <i>p</i> = 0.41, respectively). A statistically significant difference was found in AOFAS scores (<i>p</i> = 0.02). Post hoc analysis indicated that this difference was observed between the quadricortical screw and suture-button groups, with slightly higher scores in the quadricortical screw group (<i>p</i> &lt; 0.007).</p> Conclusions <p>Quadricortical screw fixation with routine removal at six weeks was associated with slightly higher one-year AOFAS scores compared with suture-button fixation, without a significant increase in overall treatment costs. However, because of the retrospective design and non-random allocation of fixation methods, these findings should be interpreted cautiously. Within the context of a standardized national reimbursement system, implant selection should not be based solely on cost, but should also take into account fracture characteristics, implant availability, surgeon experience, and patient-specific factors.</p>

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Clinical Outcomes and Cost-Effectiveness of Tricortical Screw, Quadricortical Screw and Suture-Button Fixation for Syndesmotic Injury: A Retrospective Comparative Study

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Emre Tekşan,
  • Emre Kurt

摘要

Background

The optimal fixation method for acute syndesmotic injuries remains controversial. With the increasing burden of healthcare expenditures, treatment decisions should also consider cost analysis. The aim of this study was to compare the clinical outcomes and cost analysis of tricortical screw, quadricortical screw, and suture-button fixation in patients with isolated lateral malleolus fractures associated with syndesmotic instability.

Methods

This retrospective cohort study included patients treated surgically between January 2022 and January 2025. Patients were retrospectively categorized into three groups according to the fixation method used. One-year postoperative Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and total treatment costs were compared. According to institutional protocol, quadricortical screws were routinely removed at postoperative week six, and removal costs were included in the total cost analysis.

Results

Seventy patients were included (Suture-button: 20; Tricortical screw: 19; Quadricortical screw: 31). No significant differences were observed among groups in terms of VAS scores or total costs (p = 0.73 and p = 0.41, respectively). A statistically significant difference was found in AOFAS scores (p = 0.02). Post hoc analysis indicated that this difference was observed between the quadricortical screw and suture-button groups, with slightly higher scores in the quadricortical screw group (p < 0.007).

Conclusions

Quadricortical screw fixation with routine removal at six weeks was associated with slightly higher one-year AOFAS scores compared with suture-button fixation, without a significant increase in overall treatment costs. However, because of the retrospective design and non-random allocation of fixation methods, these findings should be interpreted cautiously. Within the context of a standardized national reimbursement system, implant selection should not be based solely on cost, but should also take into account fracture characteristics, implant availability, surgeon experience, and patient-specific factors.