Clinical Research Directory

Inclusion Criteria: \- Unstable unilateral syndesmotic injuries that was considered by the attending staff surgeon to require surgical fixation, including: * Age : 18 - 60 years old. * Closed or grade I open fractures are included. * Isolated syndesmotic injury. * associated lateral malleolus fracture with talar shift. * Associated with Bimalleolar fractures. * Associated with Trimalleolar fractures that did not require posterior fragment fixation (typically \<25% of articular surface). Exclusion Criteria: \- Exclusion criteria include patient and injury specific factors. Patient-related exclusion factors included: * Skeletal immaturity. * Previous ipsilateral ankle surgery. * Non-ambulatory status before injury. * Inability to comply with postoperative protocol (i.e., advanced dementia). * Medical unfit patients for surgery. * Uncontrolled diabetes mellitus with charcot joint or peripheral neuropathy. * Polytrauma patients. Injury-related exclusion factors included: * Grade II or III open fractures * Tibial plafond fractures * Posterior malleolar fractures requiring fixation (typically \>25% articular surface involved).