BACKGROUND: Syndesmosis injuries in ankle fractures can significantly impact patient mobility and recovery, making the choice of fixation method crucial for optimal outcomes. This study aimed to compare the quality of reduction and functional results between screw fixation and dynamic fixation in treating syndesmosis injuries in ankle fractures. METHODS: This cohort study included 48 patients (28 males, 20 females) with an ankle fracture accompanied by syndesmosis injury. Twenty-four patients were treated with single-level TightRope fixation, while another 24 patients received single 3.5-mm cortical screw fixation. The clinical outcomes were measured using the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Olerud-Molander Ankle Score (OMAS), the Visual Analog Scale (VAS) score, and the Foot and Ankle Disability Index (FADI). RESULTS: The mean age of the patients was 37.3 +/- 15.1 years. The mean follow-up period was 27.6 +/- 13.5 months. There were no significant differences between the groups treated with syndesmotic screw or TightRope in terms of the mean postoperative one-year AOFAS score (89.0 and 86.0, respectively), OMAS (84.5 and 85.1, respectively), and FADI (85.4 and 86.8, respectively). The difference between preoperative and postoperative VAS scores was statistically significant (p=0.020). At the first-year follow-up, the median medial clear space was 4.3 mm (range: 2.1 to 5.7 mm) and 4.3 mm (range: 2.3 to 5.7 mm) in the two groups, respectively. The median tibiofibular clear space was 4.8 mm (range: 3.4 to 6.4 mm) in the screw fixation group and 5.1 mm (range: 4.0 to 6.8 mm) in the dynamic fixation group. Meanwhile, the median tibiofibular overlap was 7.8 mm (range: 4.2 to 10.4 mm) and 7.9 mm (range: 4.4 to 10.9 mm) for the screw fixation and dynamic fixation groups, respectively, one year post-surgery. CONCLUSION: The dynamic fixation method is as functional as the screw fixation method. Early full weight-bearing and improved pain control were noted as advantages of dynamic fixation compared to screw fixation.