<p>Ankle fractures are among the most common fragility fractures in older adults. Osteoporosis, age-related impairment of bone regeneration, and multimorbidity increase the risk of delayed union, nonunion, and postoperative complications. Besides anatomical reduction and stable fixation, adjunctive therapies aimed at enhancing biological fracture healing have gained growing interest. This review summarizes the pathophysiological aspects of fracture healing in elderly patients and evaluates current biological, pharmacological, and physical strategies to promote healing after geriatric ankle fractures. Osteoporosis is the major risk factor for impaired fracture healing, affecting both bone regeneration and implant stability. Comprehensive osteoporosis management forms the basis of adjunctive treatment. Antiresorptive therapies mainly reduce the risk of subsequent fragility fractures without significantly impairing fracture consolidation. Among osteoanabolic agents, teriparatide has shown promising effects on callus formation and fracture union. Growth factors such as bone morphogenetic proteins (BMPs) and platelet-derived growth factor (PDGF) possess osteoinductive properties but are limited to selected indications. Although platelet-rich plasma (PRP) is biologically attractive, current evidence does not support its routine use in geriatric ankle fractures. Cell-based therapies and biophysical stimulation techniques, including low-intensity pulsed ultrasound, may benefit selected high-risk patients but require further clinical validation. Early functional mobilization remains a&#xa0;key component of successful treatment. Enhancing fracture healing in geriatric ankle fractures requires a&#xa0;multimodal approach combining mechanical stability with biological augmentation.</p>