In twisting injuries of the ankle which result in a high fibular fracture (Lauge-Hansen pronation external rotation injuries) there is a disruption of the syndesmosis. It may also be injured in some transsyndesmotic fractures.
If the syndesmosis is disrupted, the fibula needs to be held in the correct position in relation to the tibia whilst the ligaments heal.
There are differences of opinions between surgeons as to:
whether and in which circumstances one or two screws should be used
whether the syndesmosis positioning screw(s) should penetrate one or both cortices of the tibia
whether and when the screw(s) should be removed
whether the screw(s) are better placed through or adjacent to a plate on the fibula