Widening of the ankle mortise following fracture can be a subtle diagnosis requiring special radiographs to fully appreciate the extent of shortening and rotation of the fibula. Once this fibular shortening has been recognized, a lengthening and rotational osteotomy can be conducted with use of a special compression/distraction device and bone graft. A series of 23 cases demonstrates that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, irrespective of the time from the original injury.