Purpose: This study was performed to compare the anatomic differences of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries. Materials and Methods: 42 patients were involved in this study: Group I was composed with 14 cases of ankle fractures with syndesmotic injuries; Group II was composed with 14 cases of ankle fractures without syndesmotic injuries; Group III was composed with 14 cases of volunteers. The height averaged 170.1 cm (range, $159{sim}181$ cm) in group I, 168.9 cm (range, $156{sim}184$ cm) in group II, and 170.4 cm (range, $161{sim}77$ cm) in group III. The mean height did not show a statistically significant difference between groups (p>0.05). All patients were taken axial computed tomography. The length of anterior and posterior facets, angle between anterior and posterior facet, and depth of the fibular incisura of the tibia were measured. Results: The mean length of the anterior facet was 11.5 mm (range, $9.2{sim}15.7$ mm) in group I, 12.2 mm (range, $7.3{sim}17.0$ mm) in group II, and 10.3 mm (range, $8.7{sim}14.0$ mm) in group III (p>0.05). The mean length of the posterior facet was 12.3 mm (range, $9.0{sim}14.5$ mm) in group I, 11.0 mm (range, $7.3{sim}16.2$ mm) in group II, and 13.0 mm (range, $9.2{sim}15.9$ mm) in group III (p>0.05). The mean angle between anterior and posterior facet was 139.1 degrees (range, $125.5{sim}154.0$ degrees) in group I, 144.2 degrees (range, $134.7{sim}152.6$ degrees) in group II, and 131.5 degrees (range, $117.6{sim}144.4$ degrees) in group III (p<0.05). The mean depth of the fibular incisura of the tibia was 4.1 mm (range, $3.2{sim}15.8$ mm) in group I, 4.6 mm (range, $3.1{sim}7.1$ mm) in group II, and 3.1 mm (range, $1.5{sim}4.0$ mm) in group III (p<0.05). Conclusion: There are some statistical differences of angle between anterior and posterior facet and depth of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries.