1. Over-Tightening of the Syndesmosis After Ankle Fracture by Dirk S. Gesink, and John G. Anderson JBJS Case Connect Volume 5(4):e85 October 14, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

2. Mortise view reveals fixation of the fibular fracture with a lateral plate and screws and a separate two-hole plate and screws placed distally for fixation of the syndesmosis. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

3. Lateral view reveals the talar dome to be centered under the concavity of the distal tibial plafond. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

4. Axial CT image reveals the distal aspect of the fibula to be well reduced in the incisura of the distal aspect of the tibia. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

5. Coronal CT image confirms widening of the tibiotalar clear space as seen on radiographs. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

6. Intraoperative image prior to screw removal shows the widened tibiotalar clear space and the narrow tibiofibular clear space. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

7. The proximal screw has been backed out of the tibia. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

8. Both screws have been backed out of the tibia but remain engaged in the fibula. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

9. After a gentle impact on the plantar aspect of the foot, the screws are again advanced into the tibia. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.

10. Lateral view confirms that the talar dome remains centered under the concavity of the tibial plafond. Dirk S. Gesink, and John G. Anderson JBJS Case Connect 2015;5:e85 ©2015 by The Journal of Bone and Joint Surgery, Inc.