Objective To compare the clinical outcomes for endobutton versus traditional screw fixation of distal tibiofibular syndesmosis in ankle fractures.Methods Sixty-nine cases of ankle fractures accompanied with distal tibiofibular syndesmosis injury hospitalized between November 2012 and November 2014 were reviewed retrospectively.Thirty-two cases (19 males and 13 females) aged (38.1 ± 15.3) years (range,22-62 years) underwent syndesmosis stabilization with endobutton system (endobutton group),and mechanism of injury was sprain injury in 20 cases,traffic injury in 7 and high fall injury in 5.Another 37 cases (20 males and 17 females) aged (33.9 ± 11.1) years (range,22-65 years) were managed with traditional screw fixation (tradition group),and mechanism of injury was sprain injury in 22 cases,traffic injury in 8 and high fall injury in 7.According to the Lauge-Hansen classification,all had pronation external rotation ankle fractures.Operation time,manipulation angle,tibiofibular clear space (TBCS),tibiofibular overlap distance (TBOL),complications and final follow-up evaluation of American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were recorded.Results Comparison of endobutton group to tradition group showed no significant differences in operation time [10 min (5-17 min) ∶9 min(4-15 min)],TBOL [(9.1 ± 1.8)mm∶ (8.2 ±2.3)mm],TBCS [(3.7 ±0.6)mm:(3.6 ± 0.9) mm],total complication rate [6.3 ％:13.5 ％] and AOFAS score [(89.1 ± 18.5) points:(86.6 ± 12.4) points] (P ＞ 0.05),but endobutton technique was associated with a larger manipulation angle [(45.8 ± 16.7) °:(28.5 ± 5.6) °] and earlier full weight bearing [(6.8 ± 1.6) weeks:(10.9 ± 2.7) weeks] than traditional screw fixation (P ＜ 0.05).Conclusion Endobutton technique has comparative effect with traditional screw fixation and has advantages such as low demand in fixation angle,early weight bearing and no need for removal of implant.