Tyler J. Van Heest,Paul M. Lafferty

Despite being common, syndesmotic injuries are challenging to diagnose and treat.

Anatomic reduction of the ankle syndesmosis is critical for good clinical outcomes.

Intraoperative three-dimensional radiography and direct syndesmotic visualization can improve rates of anatomic reduction.

The so-called gold-standard syndesmotic screw fixation is being brought increasingly into question as new fixation techniques emerge.

Syndesmotic screw removal remains controversial, but may allow spontaneous correction of malreductions.