Objective <p>Stabilization of the distal fibula and tibia to enable elongation-free healing of the ruptured syndesmotic ligaments.</p> Indications <p>Unstable syndesmotic injuries. Unstable syndesmotic injuries in combination with an ankle fracture. Subacute or chronic syndesmotic injury in combination with another procedure (debridement, fibular osteotomy, new osteosynthesis, ligament reconstruction).</p> Contraindications <p>Soft tissue infection.</p> Surgical technique <p>Stabilization of the distance between the fibula and tibia after repositioning using a&#xa0;strong suture cord, which is fixed to the cortex of the tibia and fibula via two buttons. The cord–button construct is inserted minimally invasively under image intensifier control.</p> Postoperative management <p>Two weeks of partial weight bearing with 15 kg weight, rigid ankle joint orthosis (walker) for 6&#xa0;weeks, accompanied by physical therapy.</p> Results <p>The results published to date demonstrate with strong evidence that cord-and-button fixation is superior to screw fixation in terms of clinical scores, correct reduction, and reoperation rates. This applies both to isolated unstable syndesmotic injuries and to syndesmotic injuries combined with fibula fractures. Another advantage of this surgical technique is that implant removal is not necessary in most cases. The disadvantage of this procedure is the high implant cost.</p>