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8 mm and 850.7 mm , respectively. The primary AOT group showed significantly superior improvements in clinical outcomes compared with the BMS group at last follow-up (P= .001). Fourteen patients in the primary BMS group and 2 patients in the primary AOT group experienced clinical failure. Kaplan-Meier analysis showed a superior survival rate of primary AOT (P= .042). Syndesmosis widening (hazard ratio 12.361; P= .004) and large lesion surface area (hazard ratio 1.011; P= .014) were significant relative risks of clinical failure in the primary BMS group. How
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