60 adult patients with ankle fractures requiring syndesmotic screw fixation and osteosynthesis were randomized to either have the cortical screw removed at 3 months postoperatively or left in situ. The purpose was to compare clinical, functional, and radiographic outcomes over the first postoperative year. The results at final follow-up indicated there was no advantage of screw removal over screw retention when measured over 1 year postoperatively. Ankle dorsiflexion and plantarflexion were similar, and tibiofibular clear space was smaller in patients with the screw left in situ. No significant difference in functional outcome was observed either.