Lemmers DHL, Lubberts B, Stavenuiter R, et al. - Researchers investigated the pathoetiology and incidence of adverse events after stabilization of syndesmotic instability and sought for the patient or surgeon related factors associated with unanticipated outcomes. Between January 2000 and May 2015, They identified and retrospectively evaluated a total of 849 adult patients who underwent surgical treatment with either screw or suture button fixation for syndesmotic instability with an associated closed fibula fracture. Within one year after surgery, an infectious complication occurred in 10.7% (91 patients) and unplanned reoperation was undertaken in 22.0% (187 patients). Infectious complications were noted to be correlated with the following factors: increased duration of hospital admission, use of an external fixator device before ORIF, peripheral vascular disease, and osteoporosis. They identified patients’ BMI below 30 as an associated risk factor for unplanned hardware removal specifically. Based on these findings they recommend counseling patients undergoing surgery for syndesmotic instability with associated closed fibula fracture regarding the risk of an infectious complication and a possible requirement for unplanned hardware removal.