Background: The distal tibiofibular syndesmosis is a connection between tibia and fibula that consists of the anterior tibiofibular ligament, the posterior tibiofibular ligament, the transverse ligament and the interosseous ligament. Syndesmotic ligament injuries are most often seen in combination with ankle fractures, but can occur in isolation as well. The term ‘isolated syndesmotic injury' is used for the syndesmotic rupture without ankle fracture, although concomitant other injuries may be present. These isolated injuries, which are often accompanied by deltoid ligament injuries. Objective: To evaluate the efficiency of use of syndesmotic screw fixation in treatment of acute ankle syndesmotic injury. Patients and Methods: This Prospective study included twenty adult patients with recent ankle syndesmotic injury who were treated by syndesmotic screw at Al-Azhar university hospital and mansheyat El-bakry hospital, Cairo, Egypt. Those twenty patients prospectively followed up for 12 months with average of 9 months. The clinical outcomes were calculated according AOFAS score. Results: Those 20 patients prospectively followed up for an average of 9 months. Preoperative mean value for medial clear space (MCS) was 11.8±3.9 mm, tibiofibular clear space (TFCS) was 9.2±1.6 mm and tibiofibular overlap (TFO) was 2.2±4.7 mm. while the follow up mean MCS was 3.3±0.4 mm, TFCS was 3.2±0.4 mm and TFO was measured as 11.9±1.2 mm The mean AOFAS score was 97.0±3.8 (range 90–100). Conclusion: Reduction of the syndesmosis is essential for improving functional outcomes and avoiding posttraumatic osteoarthritis. It is important to intraoperatively stress all surgically treated ankle fractures to evaluate latent syndesmotic injury.