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In this Grand Rounds presentation, UW Medicine physicians Greg Blaisdell, David Barei, and Robert Dunbar discuss current issues in the treatment of ankle fractures, one the most commonly operatively treated injuries in adults. Although often referred to as simple injuries requiring routine fixation, debate continues about how to determine ankle stability in even the simplest patterns. Orthopaedic specialists continue to rely on classification systems that help with pattern recognition, but provide little help in developing treatment algorithms. The speakers present a number of case studies to the audience of health care professionals, who are then polled on how they would treat a given patient. Standard procedures for diagnosis, treatment, and management of ankle fractures soon lead to controversy when one considers individual patients and their complicating host factors.