Six patients with chronic widening and instability of the tibiofibular syndesmosis subsequent to pronation external rotation ankle fractures were reviewed as regards diagnosis and treatment. An evaluation of the syndesmotic interval was best done by CT scans using axial cuts. Delayed reduction and stabilization using primanly large screw fixation resulted in maintenance of the reduction and satisfactory results in 5 of 6 cases. In one case, an arthrodesis of the tibiofibular interval was done because of significant incongruity.