Stabilization of the disrupted syndesmosis of the ankle may be achieved by placing a screw between the tibia and fibula to hold the syndesmosis in position until some degree of syndesmotic ligament healing can occur. The decision to use syndesmotic fixation can be based on the intra-operative stability test or intra-operative x-rays. More recently clinical studies the frequency with which syndesmotic fixation is used has been in decreasing tendency. In this retrospective review we attempted to evaluate the role of the syndesmotic fixation in the ankle fractures. Fifty-two ankle fractures with syndesmotic disruption were divided into two groups. All of the cases were treated operatively; the group I included 30 ankle fractures that were treated without syndesmotic screw, while the group II included 22 patients who had trans-syndesmotic screw fixation. There was no significant difference of the clinical results between the two groups. In all cases of Group I that had rigid medial and lateral fixation without trans-syndesmotic screw, early and late stability of syndesmosis could be achieved. The final results were not affected by the use of syndesmotic fixation. It seemed that if the status of fixation of the medial and lateral malleoli was anatomical and rigid enough, the syndesmotic fixation might be unnecessary.