The ankle joint includes the medial, lateral, posterior, and anterior ankles, with fractures of the medial and lateral ankles being the most common. In fact, the anatomical region of the ankle also includes the tibial end and the talus. Among them, a comminuted fracture near the distal tibial joint is called a pilon ( Pilon ) fracture, which has a clear indication for surgery but is more difficult to operate; a talar fracture, on the other hand, is one of the four most vulnerable areas of the body to fracture without healing and is prone to ischemic necrosis. Ankle fractures are also a very complex fracture. Fortunately, the basic issues of ankle fracture staging and mechanisms of each type are better understood, and standard treatment strategies have been established, and properly treated ankle fractures are less likely to be followed by significant functional impairment, which is a great improvement. The goal of treatment is to restore the normal anatomy of the joint and provide adequate stability for early motion. The indication for surgery depends on the damage to the articular surface on the one hand and whether the stability of the ankle joint is affected on the other. Stable nondisplaced fractures can be treated conservatively, while unstable displaced fractures are best treated with internal fixation by incision and reduction, thus obtaining anatomic repositioning and stable fixation. The determination of ankle stability depends not only on the type of fracture but also on the analysis of the damaged tissue of the soft tissue. Of course, the indications for surgery have to be mastered by considering the patient’s age, underlying disease, subjective requirements and economic situation. In the end, the indication for surgery after ankle fracture must respect the opinion of the specialist. The main indications for surgery are the involvement of the ankle joint surface and the instability of the fracture, as well as the fact that surgical treatment allows early movement and facilitates functional rehabilitation. The biggest complication of ankle fracture is traumatic arthritis, which has become less and less frequent due to the deepening of fracture treatment and understanding; the skin of the ankle is skin-over-bone, so soft tissue problems are a problem that needs attention in ankle fractures, and surgery needs to be performed after the swelling of the ankle joint has subsided, which will be safer, otherwise the bone or the internal fixation will be easily exposed. Other general fracture complications including non-union and deformed healing may also occur.