Center-Center Syndesmosis Fixation Technique

Accurate reduction is a critical component in the surgical treatment of ankle syndesmotic injuries, as it restores the joint anatomy and results in superior clinical outcomes. Data suggest a high incidence of malreduction in the treatment of syndesmotic injuries. This article describes the center-center technique for syndesmosis screw insertion. The technique defines the neutral anatomic axis of the distal tibiofibular joint, and improves the surgeon’s ability to determine the ideal start point, clamp position, and screw trajectory. The technique avoids potential malreduction caused by suboptimal clamp and screw placement. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.