Background: Management of the distal tibiofibular syndesmosis remain controversial area in the treatment of ankle fractures. The distal tibiofibular syndesmosis consists of a complex ring of ligaments and the interosseous membrane that maintain the relationship of the tibia and fibula at the ankle mortise. Disruption of these ligaments can lead to late instability, pain, and arthrosis.
Aim of the work: to evaluate the efficacy of intraoperative test for syndesmotic disruption including hook test and tap test and compare it with preoperative MRI diagnosis.

Conclusion: Obtaining an accurate syndesmotic reduction is critical to avoiding the significant morbidity that can be associated with malreduction. Anatomic reduction of the fibula and syndesmosis has been associated with improved short musculoskeletal function assessment functional outcome scores, whereas malreduction leads to instability and arthritis. This study provide detection of sensitivity of the Hook and Tap tests for detection of syndesmotic instability in relation with preoperative MRI.