Ankle fractures are frequently encountered and managed by orthopedic surgeons, regardless of subspecialty training. While many of these injuries are comprised of “simple” patterns and can be treated with an algorithmic approach, there are many nuances that must be recognized and addressed to ensure optimal outcomes. Orthopedists should appreciate history and physical exam findings that herald a more complicated course. Furthermore, the surgeon should comprehend the various positioning and surgical approaches to the ankle and when to employ them. Finally, the surgeon should be aware of various reduction and fixation strategies pertinent to given fracture patterns.