Ankle injuries gain importance because body weight is transmitted through it and location depends upon the stability of this joint. Unstable displaced and open fractures require open reduction internal fixation. Objectives were retrospective study of functional out come and results of surgical treatment of bi-malleolar fractures and to know the complications of open reduction and internal fixation in bi-malleolar fractures. Methods: The results of retrospective study of 125 patients were

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... from January 2009 to January 2015. They were classified according to Lauge Hansens classification and treated according to the AO system. Assessment of the outcome was done using the scoring system of Baird and Jackson which is based on subjective, objective and radiological criteria. Results: Mean follow up was 3.5yr in between January 2009-January 2015. Out of 125 patients evaluated, overall good to excellent results were obtained in 95 (76%) patients. The results were fair in 15 (12%) and poor in 15 (12%) patients. There were no intraoperative complications. The post-operative complication we came across is superficial skin infection in 20 (16%) patients. Interpretation and conclusion: Anatomical reduction is essential in all intra articular fractures, more so if a weight bearing joint like ankle is involved open reduction and internal fixation guarantee high standard of reduction besides eliminating chances of loss of reduction. The fibular length has to be maintained for lateral stability of the ankle. Chances of non-union of medial malleolus interposition of the periosteum and deltoid ligament are avoided. Poor clinical results are found to be associated with unsatisfactory surgical reduction.