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

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Comment to high fibular fractures

The fracture of the proximal fibula is only indirectly reduced and not directly fixed. This fracture type is the most unstable type, always resulting in an instability of the syndesmotic complex. Restoration of length, axis and rotation of the fibula are of primary concern. Accompanying fractures are fixed thereafter.


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The instability of the ankle joint is treated with two positioning screws after exploring the syndesmotic complex and achieving perfect reduction of the distal tibiofibular joint.