97 patients with either an isolated syndesmotic injury or concomitant with an AO/OTA type 44C ankle fracture were randomized to syndesmotic stabilization with either a suture endobutton device or a syndesmotic screw. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Olerud-Molander score, ankle dorsiflexion and CT-assessed tibifibular distance of the operated versus nonoperated ankle, complications, and reoperations. Follow-up was scheduled at 6 weeks, 6 months, and 12 months after surgery. Results for the AOFAS ankle-hindfoot and Olerud-Molander score significantly favoured the suture endobutton group compared to the syndesmotic screw group at 6 and 12 months postoperatively. The rate of excessive difference in anterior and central TFD (>2mm) between ankles was significantly lower in the suture endobutton group compared to the syndesmotic screw group.