51 patients with malleolar fracture and concomitant syndesmosis injury, and who were to undergo open reduction and internal fixation alogn with syndesmosis stabilization with a tricortical screw, were randomized to one of three groups: preoperative bilateral CT, preoperative unilateral CT of the fracture ankle only, or no preoperative CT. Patients were assessed primarily for outcome on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score after 12 months. Secondary outcomes included postoperative CT parameters and incidence of complications. Results for the primary outcome demonstrated significantly higher AOFAS ankle-hindfoot score at 12 months in the preoperative bilateral CT group compared to both the preoperative unilateral CT group and the no preoperative CT group. Postoperative CT results also suggested better anatomical restoration of the ankle joint in the preoperative bilateral CT group.