Is to present our clinical experience in how we evaluate ankle fractures as unstable and the use of syndesmosis screw in their treatment. Since 2004–2008, 85 ankle fractures treated surgically. Of them 31 were evaluated as unstable according to:
preoperative x-rays findings intraoperative tests, and syndesmosis screw was used. We used AO-Weber classification: 14 cases type B(7 cases of B2 and 7B3), 16 cases type C(4 cases of C1 and 12 C2). Twenty-one of them were females and 10 were males. Their age rage was from 17–61 years old (Mean 42,5).The follow-up was from 6 months to 4 years(Mean 2,5 years). Syndesmosis screw was removed afters six weeks. Postoperative results were evaluated according the scoring system of Olerud and Malander. Postoperative there were 2 ankle O.A.(6,45%) due to false surgical technique. They treated by arthrodesis. The proper evaluation of the first x-ray findings of the fracture is of great importance for the proper treatmet. The syndesmosis screw is obligatory in unstable ankle fractures, in which, in combination with proper osteosynthesis preserves the ankle’s stability and viability. Ligament and bone lesions are responsible for ankle stability