Ankle fractures are amongst the most common traumas that undergo surgical fixation. Syndesmotic injury can complicate the fixation and has its shares of postoperative complications, however it is uncertain if there are specific factors that may increase the risk of a complicated postoperative course. In this study the authors identify certain factors which increase adverse events including use of external fixator device prior to ORIF (OR 5.19) and PVD (OR 4.33). This indicates that there are certain groups of patients that may are at an increased risk for complications.