Objectives To improve diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements at MIMS Mandya, and to establish local reference values to prevent malreduction and over compression during surgical treatment. methods A descriptive observational study at the Department of Orthopaedics, MIMS Mandya. Standard AP and lateral ankle radiographs of adult patients were analyzed. Measurements included TFO, TFCS, MCS, SCS on AP views, and ATFI, PTFI, ATFR on lateral views. Correlations with age, gender, and side were assessed. Results AP measurements: TFO 8.0±2.4 mm, TFCS 3.8±0.9 mm, MCS 3.3±0.4 mm, SCS 3.3±0.3 mm. TFCS showed no significant variation with age, gender, or side. Lateral measurements: ATFI 12.8±2.4 mm, PTFI 6.1±2.9 mm, ATFR 0.4±0.1. ATFR was consistent across all demographic groups and demonstrated high bilateral symmetry. Conclusion Combining AP and lateral radiographic parameters improves syndesmosis diagnosis reliability. TFCS is reliable for intraoperative over compression avoidance; ATFR on lateral radiographs is recommended to prevent malreduction. Normative values enhance diagnostic precision and surgical outcomes.

Malreduction, Over Compression, Radiological Diagnosis, Syndesmosis Injury, Tibiofibular Overlap, Tibiofibular Clear Space, Anterior Tibiofibular Ratio.