الفهرس 
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Abstract
Ankle fractures are one of the most common lower extremity injuries. Ankle fractures can be classified by Danis- Weber classification which describes the injury based on the location of the lateral malleolar fracture. Fractures may be classified as A, B, or C with a fracture below, at the level of, or above the syndesmosis respectively.
Another widely used classification is Lauge-Hansen classification which classifies ankle fractures upon the position of the foot at the time of fracture (supination or pronation) and the deforming force at the ankle (abduction, adduction, internal rotation, or external rotation). There are four resulting classes of injury: Supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PAB).
The distal tibiofibular syndesmosis is a fibrous joint composed of the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), the transverse ligament and the interosseous tibiofibular ligament. Together, these ligaments maintain the stability between the distal tibia and fibula, thereby providing a deep mortise joint for articulation with the talus. The PITFL give 42% of resistance strength, compared with 35% for AITFL and 22% for the interosseous tibiofibular ligament. When these ligaments are ruptured in a severe high ankle sprain, the distal fibula migrates and can no longer provide a stable lateral buttress for the ankle mortise. If left untreated, patients with this injury may develop chronic pain, instability, and eventually degenerative joint disease of the tibiotalar joint.
Fixation of the tibiofibular syndesmosis after reduction is the preferred treatment of severe syndesmotic injuries. Additionally, applying unstable fixation to a reduced syndesmosis or stable fixation to a malreduced syndesmosis can lead to poor function. Therefore, there are many techniques for such operation including number of screws, diameter and design of the screw, number of cortices engaged and need for removal before weight bearing.