Design The R3FLEX™ Stabilization System is the next generation of flexible fixation for the syndesmosis The instrumentation provides surgeons the ability to assess and adjust the tension of the repair intra-operatively The preparation is performed tri-cortically with a Ø2.8 mm drill bit to alleviate the risk of injury to the saphenous nerve or vein on medial distal tibia The knotless implant is designed to enable motion across the syndesmosis to better match the native kinematics of the fibula Placement The R3FLEX implant should ideally be placed 1.5cm to 3cm above the ankle joint, depending on if two implants are used, size of patient, hole location in the plate, and the location of the fracture Indications Syndesmosis Repair Approaches Position the patient supine such that the foot is near the end of the table, or in lateral decubitus, based on surgeon preference or fracture pattern The incision placement is dependent on surgeon preference for fracture pattern and/or isolated syndesmotic instability as well as anticipated plate length and location(s) The surgeon should address other fractures of the ankle prior to syndesmotic fixation, according to patient injury and surgeon training If a deltoid injury or medial malleolus fracture is to be repaired, that should be done first If there is a deltoid ligament injury requiring evaluation or repair, expose the anterior medial ankle and evaluate the joint, and remove any soft tissues in the medial clear space prior to syndesmotic reduction It is imperative to properly reduce the lateral malleolus prior to placing the syndesmotic device Drills Ø2.8mm Drill Ø3.8mm Drill