a longer-term cohort study that confirms that syndesmotic reduction can be maintained over the early time frame following syndesmotic injury (average follow-up, 20 months). The fact that osteolysis around the device occurs is not surprising or of concern. The fibula rotates with ankle dorsiflexion and plantar flexion, and internal fixation devices will break or resorption occurs in the bone around the implant; this is true for screws as well. A randomized controlled trial, adequately powered and likely multicenter, comparing the suture endobutton device with screw fixation is heavily anticipated. M. F. Swiontkowski, MD A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types Kemler E, van de Port I, Backx F, et al (Univ Med Centre Utrecht, the Netherlands; et al) Sports Med 41:185-197, 2011 Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effective- ness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, pub- lished between 1990 and April 2009 that compared ankle braces as a treat- ment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treat- ment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. TubigripÔ, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported posi- tive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of Chapter 3eTrauma and Amputation / 93