Although ankle fracture-dislocations are common orthopedic injuries, it is very uncommon for them to be irreducible, and such cases require special attention. We report the case of a closed fracture-dislocation of the ankle in a 17-year-old male that required 3 surgeries because of persistent anterior subluxation of the talus on the postoperative radiographs. After advanced radiologic investigations, tibialis posterior tendon interposition in the syndesmosis was identified as the cause of the subluxation. This is a very rare event, reported in only 5 patients in published studies. Once the diagnosis was identified by magnetic resonance imaging, the tendon was relocated to its anatomic position, and the tibiofibular and tibiotalar joints were reduced adequately. The patient was then able to regain a satisfactory level of function many months after the initial trauma.
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