Syndesmotic injuries usually occur after ankle fractures, but they can also be seen as isolated injuries. Anatomical reduction is mandatory in these intraarticular injuries. Although classical treatment for syndesmotic injuries is screw fixation, there are many controversial topics about this method. In the literature no difference was found between 3.5 and 4.5 mm screws and between three or four cortex fixation. There is also no concensus about the necessity of screw removal. In recent years suture button implants have become more commonly used for these injuries. These implants have the theoretical advantage of dynamic fixation without any need of implant removal. Another topic of discussion is the evaluation of the reduction after fixation of syndesmotic injuries since high ratio of malreduction has been detected at postoperative computerized tomography investigations.

Isolated syndesmotic injuries are relatively rare. These injuries are usually referred as high ankle sprain. Patients with occult or frank instability require surgical treatment but the diagnosis of these patients is usually difficult. In patients without instability the duration of conservative treatment is usually longer than other ankle sprains.