Ankle fractures are the second most common lower limb fractures after those involving the hip, accounting for 10% of all fractures, with an incidence that has been increasing.1,2 The goal of management is to restore a stable and congruent joint. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures. In this video, Dr. Weaver walks us through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Dr. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures.