This biomechanical study compares two methods of internal fixation of the tibiofibular syndesmosis used in Weber type C maileolar fractures of the ankle. The transverse syndesmotic 3.5-mm screw was compared with two 1.5-mm Kirschner wires introduced obliquely across the distal tibiofibular syndesmosis. The influence of implants on distal tibiofibular joint motion and contact characteristics of the intact ankle joint were determined. Up to 1.25 mm of lateral displacement and 2[degrees] of external rotation of the lateralmalleolus during uninjured ankle dorsiflexion was recorded. Both techniques stabilized the injured syndesmotic joint and limited its normal motion during flexion and extension of the ankle. Pressure distribution displaced laterally in internally stabilized ankles compared with intact specimens, regardless of the type of fixation used. Therefore, both techniques alter joint biomechanics equivalently compared with the intact ankle.