Background; Tibiofibular diastasis can be found in ankle fractures and it may be the cause of ankle instability. Aim: to compare the accuracy and maintenance of syndesmotic reduction using tightrope fixation versus syndesmotic screw fixation and their correlation with clinical outcome. Methods; 40 patients with syndesmotic injuries who were evaluated before and after fixation by screw (Group A) and by Tightrope (Group B) in the period between November 2016 and January 2019. Exclusion criteria were patients with diabetes mellitus, neuropathic arthropathy or elderly patients with severe osteoporosis. This study included 40 patients with disrupted inferior tibiofibular syndesmosis in addition to malleolar fractures. Results: The mean age of the patients was 33.5years.the percentage of males was 77.5% and of females was 22.5%. According to Denis-Weber classification; 6 fractures (15%) were of type B while 12 fractures (30%) were of type C and there were 22 patients (55%) with isolated syndesmotic disruption. Half of the patients were treated using syndesmotic screw, and the other half with tightrope the mean American Orthopaedic Foot and Ankle Score was 91.5. The overall results were considered as satisfactory in 38 (95%) patients; 33 (82.5%) were excellent and 5 (12.5%) were good and only two (5%) patients were unsatisfactory, the two were fair, no patients were considered as poor. Conclusion; Tightrope provides a valid option for the treatment of tibiofibular diastasis. It is simple, safe and effective with no secondary surgery for removal of syndesmotic closure procedure in comparison for screw removal mentioned in the literature