Kaiser PB, Riedel MD, Qudsi R, et al. - Researchers sought to radiographically map the anatomic course of structures on the medial aspect of the distal tibia to be able to at-risk zones for syndesmotic fixation. They dissected 18 fresh-frozen cadaveric ankle specimens and recognized the saphenous neurovascular bundle (SNVB) and the posterior tibial tendon (PTT); these were marked with copper wiring. Using a grid system consisting of 3 columnar zones from anterior to posterior and five 1-cm rows, they analyzed standardized and calibrated lateral radiographs of the distal tibia and fibula and outlined the anatomic course of the SNVB and the PTT. In 97.3% of specimens, the location of the SNVB was in the more anterior zones (1, 2, or anterior to Zone 1). As SNVB descended proximal to distal, it traversed from posterior to anterior. They identified the PTT in Zone 3 (most posterior zone) in all specimens. In 83.3% (15 of 18) of specimens, the PTT was noted to pass behind (radiographically overlap) the tibia between 1 and 3 cm above the tibiotalar joint. Structures on the medial ankle are at risk given the placement of quadricortical syndesmotic fixation. The SNVB along the anterior course of the distal tibia is at considerable risk, while the PTT is only at risk in zone 3 at the distal extent of the tibia.