Background: There is a wide debate about the necessity and timing for syndesmotic screw and removal. Objective: The aim of the current work was to assess the improvement in functional and radiological outcome after syndesmotic screw fixation and removal. Materials and Methods: This prospective cohort study included a total of 18 patients who underwent ankle fracture surgery with syndesmotic fixation, attending at Department of Orthopedic, Zagazig University Hospitals and Sharq El-Madina Hospital. Patients were divided into two groups: Group (I): included 9 patients who underwent ankle fracture ORIF with syndesmotic fixation followed by subsequent syndesmotic screw removal (SSR). Group (II): included 9 patients, who underwent ankle fracture ORIF with syndesmotic fixation without subsequent SSR. Result: Clinical and x-rays results were similar in both groups at follow-up. There were no significant differences between both groups regarding to clinical data, clinical outcomes, radiological outcomes, and complications. Conclusions: It could be concluded that syndesmotic screw removal is not necessary. Removal's timing of the device must guarantee the complete healing of the injured syndesmotic soft tissues.