The syndesmosis is the distal articulation between the tibia and the fibula. It is important for the stability of the ankle and load transfer, and it is often injured in ankle sprains and fractures. Ankle injuries are the most common sports injuries. The incidence of syndesmotic injury is 5–10% in ankle sprains, while it is 11–20% in surgically treated ankle fractures. The duration of returning to the sports after the syndesmotic injury is two times longer than that after the sprain. Early diagnosis and appropriate treatment are important because overlooking the injury or inappropriate treatment leads to poor functional outcome in the patient. The treatment of syndesmotic injuries is difficult; and even if it is diagnosed and treated, a slight amount of malreduction may lead to joint damage and poor functional outcomes.