Technique Tip: Using a Targeting Guide to Place Flexible Syndesmosis Fixation, in Ankle Fractures with a Dual Plate Construct

Syndesmosis disruption alone or accompanying an ankle fracture is a frequent injury addressed by the foot and ankle surgeon. Reduction and fixation are usually performed with the use of implants as a tight rope and/or screw(s). When treating complex articular injuries requiring multiple buttress plates, the ability to enhance fixation with syndesmotic implants can be difficult in the presence of other hardware. We propose a technique using an anterior cruciate ligament targeting drill guide to precisely place syndesmotic fixation across both plates to achieve the ideal construct for stability. In this case, we used flexible fixation for the syndesmosis. Level of Evidence: Diagnostic level V; expert opinion.