Inclusion Criteria:  Adults 19 years of age and older. Isolated rotational ankle injury Syndesmotic instability (determined either pre- or intra-operatively) Length-stable fibula fracture pattern  Exclusion Criteria:  Open fracture Length-unstable fracture pattern (including Maisonneuve fracture pattern) Syndesmotic stability (determined either pre- or intra-operatively) Lower extremity neuropathy History of prior trauma or surgery to injured ankle Non-ambulatory patient Baseline use of ambulatory assistive device prior to injury