Background: About 18% of all fractures are ankle fractures. Injury of the ankle with syndesmotic ligaments usually causes instability and may require specific intervention beyond the fixation of the fracture. The syndesmotic injuries, that are isolated without displacement, are not treated surgically. But those with concomitant fractures should be treated surgically. Aim of the study: To assess the outcomes of dynamic fixation by tightrope and static fixation by conventional 3.5 mm cortical screw in patients with acute syndesmosis injuries. Patients and methods: this is a clinical trial conducted on 40 patients with acute syndesmosis injuries recruited from January 2018 to September 2020. Patients were divided into two groups according to the type of treatment. The first group were treated with a conventional 3.5 mm conventional cortical screw (Group A) and the other group were treated by ORIF using an Arthrex tightrope (group B). Results: The average age of the included patients was 26.8±4.67 in Group A and 28.2±6.3 in Group B. The overall AOFAS score was significantly higher in patients in Group B than patients in Group A after 3 months of follow-up (64.75±10.9 versus 58.5±12.9, respectively) P=0.05 and at 24 weeks follow-up (94.15±5.35 versus 86.95±11.45, respectively) P=0.005.