One hundred and fifty patients with a displaced fracture of the ankle caused by external rotation-abduction forces were treated by open reduction and rigid internal fixation. After an average follow-up of three and one-half years, the results were satisfactory in 90 per cent. Less satisfactory results were noted in the more severely injured ankles. We found that the ruptured deltoid ligament did not need to be repaired if the lateral side was anatomically and rigidly fixed;​ in the Maisonneuve fracture, restoration of the fibular length was as important as stabilization of the fracture;​ with the use of the suprasyndesmotic screw, walking was permissible with the screw in situ;​ conforming the plate to the bend of the lateral malleolus was essential;​ and as much as two millimeters of lateral residual displacement of the lateral and medial malleoli was compatible with a satisfactory result, as was a similar displacement of the talus provided there was anatomical restoration of the lateral side.