High ankle sprain fixation is an operation to stabilise the syndesmosis — the ligament complex that holds the tibia and fibula together above the ankle joint. It is performed for unstable syndesmotic injuries that will not heal with conservative management.
The syndesmosis is reduced (the fibula is positioned correctly in the tibial notch) and held with one or two fixation devices. Options include syndesmotic screws (metal screws through both bones, removed at three to four months), suture buttons (TightRope — a strong suture connecting two buttons on the tibia and fibula, usually not removed), or a combination. The operation takes 30–60 minutes and may be combined with ankle fracture fixation.
Surgery is recommended for unstable syndesmotic injuries — those with widening of the tibiofibular joint on stress X-rays. Isolated stable syndesmotic sprains can be managed in a boot. Unstable injuries that are not fixed lead to chronic ankle instability and arthritis.
Walking boot and physiotherapy for stable syndesmotic sprains. Stable injuries heal well without surgery, though recovery takes longer than a standard ankle sprain (six to twelve weeks).
Weight-bearing X-rays and stress views. CT may be used to assess fibular position. MRI to assess ligament integrity.
Restoration of syndesmotic stability preventing chronic widening and arthritis. Most athletes return to sport at four to six months.
Syndesmotic screws restrict normal tibiofibular motion and are removed at three to four months. This requires a second procedure.
Temporary ankle stiffness.
Longer than a standard ankle sprain.
If the screw breaks before removal due to premature weight-bearing.
The fibula may be fixed in a suboptimal position.
After screw removal or suture button failure.
Bone formation in the interosseous membrane.
Wound infection.
General or spinal anaesthesia with ankle block.
Non-weight-bearing for six weeks (screws) or partial weight-bearing (suture button). Boot for six to eight weeks. Screw removal at three to four months. Progressive ankle rehabilitation. Return to sport at four to six months.
X-rays at two weeks, six weeks, and three months. Screw removal at three to four months if applicable.
The syndesmosis is the ligament complex (anterior tibiofibular ligament, posterior tibiofibular ligament, interosseous membrane, and transverse ligament) that holds the tibia and fibula together just above the ankle joint. It is critical for ankle stability.
Both are effective. Screws are well-established but require removal. Suture buttons allow some physiological motion and usually do not need removal. Your surgeon will recommend the best option.