We welcome Foot & Ankle Specialist and Residency Director of Loyola University Medical Center, Dr. Adam Schiff, MD to discuss suture button versus screw fixation for ankle syndesmotic injuries.  We review the study “Comparison of Suture Button and Syndesmotic Screw for Ankle Syndesmotic Injuries: A Meta-Analysis of Randomized Controlled Trials“ published in OJSM in January coming to us from Southwest Hospital of Army Medical University in Chongqing, China.  In the study, Dr. Kang-Lai Tang and his team found no difference in terms of malreduction, however the suture button group had significantly lower rates of local irritation and unplanned reoperation.  Dr. Schiff lends his expertise on this topic, lays out the pros and cons of each approach, the historical perspective, and what situations might be best suited for each treatment construct.