Ankle fractures are the most common osseous injuries of the lower extremity. In most cases, open reduction and internal fixation is indicated due to fracture dislocation. Operations of the ankle are generally considered classic, standardized, training procedures. An exact reconstruction with correct length and rotation of the joint as well as stabilization of the tibiofibular ligamentous complex is essential. Beside age and gender of the patient, outcome depends on fracture morphology and comorbidities, e. g., osteoporosis, vascular status, neuropathic disorders, and diabetes mellitus. Additional chondral lesions, extensive closed or open soft tissue injuries, and compartment syndrome due to trauma impact can lead to further problems in the postoperative period. Furthermore, iatrogenic complications like fixed malpositions, instabilities, and implant-associated failure of osteosynthesis may also occur. This article illustrates the causes of preventable mistakes and points out options to increase clinical outcome.