This video highlights the presentation, diagnosis, and surgical management of ankle malunions. The video discusses the case presentation of a patient with a shortened lateral malleolus and persistent syndesmosis widening. The indications and surgical outcomes of ankle fracture malunion repair are reviewed. The video demonstrates a lengthening lateral malleolus osteotomy followed by plate fixation and syndesmosis fixation with the use of a suture-button construct. The technique for fibular nail removal also is demonstrated.