The distal tibiofibular syndesmosis consists of 4 ligaments and the interosseous membrane. The ligaments are the anterior inferior tibiofibular ligament, the interosseus ligament (thickened distal portion of interosseous membrane), and the posterior inferior tibiofibular ligament and its distal portion, which constitutes the inferior transverse ligament.3 Disruption of these structures can lead to syndesmotic instability as well as diastasis of the fibula from the tibia, which results in displacement of the talus. Computed tomography of ankle fractures with syndesmotic injury has shown that the distal fibular fragment and thus the talus are externally rotated relative to the tibia and the proximal fibular fragment.4 As originally shown by Ramsey
