Introduction: Ankle fractures in the elderly is on the increase both in prevalence and severity. The major goal of treating displaced fractures in the elderly is rapid resumption of mobility. Review of literature showed better outcome was achieved by Open Reduction and Internal Fixation. Aim: to study the complication and reoperation rates following ankle fractures in the elderly population. Method: We studied the outcome following displaced ankle fractures in patients above the age of 55 admitted to Good hope hospital over the last þve years. The study was conducted on retrospective basis with a review of notes and x rays to assess the outcome. Result:The rate of complications and re-operation rate were studied. A total of 62 patients were identiþed with a mean age of 70. MUA and cast immobilisation was used in 13 patients, 3 patients treated with MUA and Percutenous K wire þxation and 41 patients were treated with Open reduction and internal þxation. One case in the MUA and cast immobilisastion group needed ORIF (7%). In the ORIF group, one case had to be re-operated to introduce a syndosmosis screw due to residual talar shift. The rate of complications in the ORIF group was 17%. Wound infection and delayed wound healing were the main complications. Based on the results of this audit, we believe that MUA and cast immobilisation supplemented with K wire þxation if necessary should be used as a þrst line of management in the elderly. Conclusion:The use of Open reduction and internal þxation should be reserved for þt and mobile patients with no circulation problems or osteopenia in order to avoid bone healing and wound complications.