Fig. 1

Detailed steps of the intraoperative fixation of the distal tibiofibular syndesmosis using the encircling and binding technique. A A 2.5-mm Kirschner wire placed on the anterior edge of the fibula is used to create a bone canal. B Use of a threading device to introduce double-strand sutures from the inside to the outside through the bone canal. C, D Vascular clamp blunt separation, close to the posterior edge of the tibia, clamping the medial double strands and pulling back to the outside. E Making the nice knot on the posterior edge of the fibular plate. F After obtaining satisfactory tension, 3–4 single-wire knots fixed to the nice knot form an encirclement