From 7 included RCTs, moderate quality of evidence suggested that suture button fixation was safer than screw fixation as the risk of reoperation was significantly lower [relative risk (RR): 0.48, 95% CI: 0.24 to 0.96]. Moreover, we found that suture button fixation was superior to screw fixation as suture button significantly reduced pain [mean difference (MD): -5.22, 95% confidence interval (CI): -9.60 to -0.84, moderate quality of evidence] and improved the score of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale (MD: 3.31, 95% CI: 0.10 to 6.52, moderate quality of evidence) at <= 3 months after fixation. However.....