{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T08:01:14Z","timestamp":1789891274000,"version":"4.0.1"},"reference-count":46,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Syndesmotic fixation in ankle fractures remains controversial. Hybrid fixation combines a suture button device and a syndesmotic screw, but comparative evidence remains limited. This study compared hybrid, suture button (SB), and screw fixation in isolated Danis Weber type B or C fibular fractures requiring syndesmotic stabilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study evaluated 90 patients. Groups were Hybrid (n\u2009=\u200928), SB (n\u2009=\u200931), and Screw (n\u2009=\u200931). The primary endpoint was 6-month Olerud Molander Ankle Score (OMAS). Secondary outcomes included visual analog scale (VAS) score, serial OMAS values, 12-month ankle range of motion (ROM), radiographic measurements, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Six-month OMAS did not differ significantly among groups (Hybrid 82.32\u2009\u00b1\u20097.51, SB 79.35\u2009\u00b1\u20099.29, Screw 77.10\u2009\u00b1\u20098.24,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.091). Plain radiographic measurements were similar throughout follow-up. At 12\u2009months, operated to intact ROM percentage was higher in the SB group than in the Screw group (82.69%\u2009\u00b1\u20099.77% vs 79.54%\u2009\u00b1\u20097.71%, adjusted\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.049). The difference was small, approximately 3.15\u2009percentage points, corresponding to 2.68\u00b0 of operated-side total ROM. Complication rates remained similar, including and excluding screw breakage (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.495 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.361).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Hybrid fixation was not associated with significantly higher 6-month OMAS compared with SB or screw fixation. Because this study was powered for a large effect and was not designed for noninferiority or equivalence, smaller group differences cannot be excluded. The proportion of patients achieving the OMAS MCID threshold was higher in the Hybrid group (85.7%) than in the SB and Screw groups (both 32.3%), reflecting larger within-group score improvement from 12\u2009weeks to 6\u2009months rather than differences in absolute 6-month scores; the clinical significance of this finding is uncertain. The small ROM percentage difference favoring SB over screw fixation was hypothesis generating and of uncertain clinical relevance. These findings suggest that hybrid fixation is a clinically usable option, but future prospective studies should clarify whether combined dynamic and static stabilization offers added value in selected fracture patterns, instability profiles, or patient subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007261462530","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:20:33Z","timestamp":1785144033000},"page":"1148-1159","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid, Suture Button, and Screw Fixation for Syndesmotic Stabilization in Isolated Danis Weber Type B and C Fibular Fractures"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-7023","authenticated-orcid":false,"given":"Numan","family":"Mercan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmara\u015f Necip Faz\u0131l City Hospital, Kahramanmara\u015f, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5151-6478","authenticated-orcid":false,"given":"Tevfik","family":"\u00c7atal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmara\u015f Necip Faz\u0131l City Hospital, Kahramanmara\u015f, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000937"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-017-9389-4"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-022-09769-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518804804"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v7.i11.718"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120946744"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B11.BJJ-2016-0202.R1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04834-0"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716661221"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-024-05354-x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2026.113054"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm15010107"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720964799"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08761-5"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-17-00417"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.3.170057"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078901000308"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.5606\/ehc.2020.71132"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10100812"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01287"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01537"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2003.10.013"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06067-5"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.0841"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100718809066"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01476"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193146"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-022-04533-y"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2025.12.035"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2018.11.008"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1645-7"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181bedca1"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-010-1225-x"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13164805"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640020932049"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2022.05.007"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602701005"},{"issue":"2","key":"e_1_3_2_40_2","first-page":"98","article-title":"Syndesmotic 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