1. Open treatment of ankle fractures is discussed. 2. It is our opinion that operative treatment affords the most predictable way to carry out an absolutely anatomic reduction of the fractures. In addition, the joint may be inspected, cartilage damage documented, and loose fragments removed. 3. A logical method of fixation has been discussed. It is stressed that the fibula should be fixed anatomically first and then associated instabilities corrected. 4. A series of cases with a relatively short follow-up period has been presented showing excellent results and a low complication rate when this approach is used. 5. The recommendation for open reduction of S-ER II fractures has been made. 6. It has been suggested that the deltoid ligament does not need to be repaired when fibular reduction is anatomic and fixation is stable. 7. Syndesmosis screws are rarely indicated, except in high C fractures when corrected by indirect methods.