Background <p>This study aimed to compare the clinical and radiological outcomes of the embrace fixation (EF) technique with those of suture button fixation (SF) for syndesmotic injuries in ankle fractures, with a focus on postoperative CT-assessed reduction quality, functional scores, and complication rates.</p> Methods <p>A retrospective cohort study was conducted on 148 patients (86 EF and 62 SF) treated between January 2021 and January 2023. Preoperative and postoperative assessments included radiographies and 3D-CT scans, American Orthopedic Foot &amp; Ankle Society (AOFAS) hindfoot scores, Olerud-Molander Ankle (OMA) scores, and visual analog scale (VAS) pain scores. The primary outcome was the AOFAS hindfoot score at the final follow-up.</p> Results <p>Both groups demonstrated excellent clinical outcomes, with no significant differences in AOFAS, OMA, or VAS scores. Postoperative CT analysis revealed low malreduction rates. The complication rates were comparable and primarily involved minor soft tissue irritation.</p> Conclusion <p>Both the embrace and suture button techniques demonstrated comparable accuracy and effectiveness for syndesmotic stabilization in ankle fractures and yielded excellent radiological and clinical outcomes. Notably, the embrace technique yielded equivalent outcomes compared with suture button fixation for managing syndesmotic injuries.</p> Level of evidence <p>Level III, retrospective case-control study, therapeutic.</p>