Three patients with ankle fractures are presented to demonstrate poor results due to improper application of a syndesmotic screw. In these cases failure of surgical treatment caused accelerated disruption of the ankle mortise with cartilage wear, or instability and joint distraction. Simple internal fixation with a single screw requires strict awareness of the potential harm that can be inflicted on the joint. The syndesmotic screw has to be inserted with a proper understanding of the biomechanics of ankle joint structures.