The general consensus of the treatment for ankle fracture is anatomical reduction and restoration of the distal tibiofibular relationship. In general, stabilization of the disrupted syndesmosis may be achieved by repairing ruptured ligament; fixing associated fractures of the fibular, avulsed tubercles, and medial malleolus; or by placing a screw between the tibia and the fibular to hold the syndesmosis in position until some degree of syndesmotic ligament healing can occur. However, the managements of syndesmosis remain controversial. The purpose of this study is to evaluate the effect of the syndesmotic fixation in the ankle fractures. The patients with syndesmotic disrupted ankle fracture, who were treated operatively between 1990 and 1995 at St. Benedict Hospital, were divided into the two groups based on whether trans-syndesmotic screw was used or not. The group I included 42 ankle fractures that were treated with trans-syndesmotic screw, while the group II included 28 ankle fractures that were treated without syndesmotic screw. The results obtained from this study were as follows. 1). There was no significant difference of the clinical result between the two groups. 2).When the diastasis was satisfactorily reduced after rigid, anatomic medial and lateral fixation, syndesmotic screw fixation was not required to maintain the integrity of the tibiofibular joint.