Injuries to the ankle syndesmosis—the ligamentous complex that provides stability to the ankle—are relatively common, particularly in the setting of ankle fractures. Plain radiographs with stress maneuvers remain the principal tool for diagnosis, and often concomitant ankle fractures must be definitively stabilized before a syndesmotic injury can be ruled out. Syndesmotic injuries can be reduced with manual compression or with a clamp. Reduction quality can be assessed fluoroscopically, through an open approach, or with advanced intraoperative imaging. Screws and suture button devices are options to definitively stabilize syndesmotic injuries. Caution should be taken to avoid overcompression or malreduction of the syndesmosis.