Debate continues in the current orthopedic literature regarding advantages of performing concurrent fibular stabilization in combined distal tibial and fibular fractures. In this case report, we present the correction of tibial malalignment, fibular fixation, and syndesmotic restoration in a 21-year-old male after a high-energy injury where he sustained a fracture of the tibia and fibula at the same level that was initially managed with tibial nailing alone. After initially having delayed union, valgus malalignment and resultant syndesmotic pain and instability following the index surgery, he underwent revision surgery resulting in favorable recovery with cessation of his pain and correction of his malalignment.