Ankle fractures and ligamentous injuries at the lateral ankle are among the blockbusters in trauma of the lower leg [1]. The intermediate and long-term outcome with around 10 % of patients with symptomatic osteoarthritis is not that good as often presumed [2]. Despite the ubiquitous high incidence of malleolar fractures and in knowledge of the fact that with increasing number of the involved malleoli, in particular, of the posterior ankle and the need for placing a positioning screw, the prognosis is getting worse and evidence-based recommendations for treatment are lacking [1, 3–5]. Presence of fracture dislocation at injury, articular surface congruity and residual talar subluxation are obviously relevant prognostic parameters [3]. Of course, the mantra of anatomical and functional restoration of any particular lesion may represent our general guideline for treatment of ankle fractures, but, it does hardly substitute the need for prospective multicentre studies to clarify the prognostic value of fragment size which has been regarded as a relevant parameter for decision making in refixation of posterior malleolar fractures for decades [3, 4].

Bartoníček et al. [6] supply us a with a new classification of posterior malleolar fragment which relies on preoperative CT analysis of the ankle joint and has clinical implications regarding the need for fragment refixation and the optimized selection of the surgical approach. Rammelt et al. [7] underscore that syndesmotic disruptions are frequently associated with bony avulsions or malleolar fractures which make anatomic reduction within the incisura necessary. Malreduction is one of the major risks in these patients which should be ruled out by intraoperative 3D fluoroscopy or postoperative CT scan to avoid long term complications.

Our actual focus is not limited to the most frequent ankle lesions, but refers to further entities of ankle trauma which may be under diagnosed or underreported [8, 9].

Lötscher et al. [10] concentrate on the various types of injuries on the medial side of the ankle joint which range from ligamentous injuries to fractures or combination injuries. Missed injuries bear an inherent risk of poor outcome. Thus, adequate diagnosis and selection of treatment is decisive. Mittlmeier et al. [11] address acute and chronic subtalar joint instability which is easily misinterpreted as a ligamentous injury of the ankle joint and might result in complaints due to chronic instability. Chronic subtalar joint instability is still a topic with quite heterogeneous proposals for surgical treatment despite promising short-term outcome of various techniques.

Finally, Espinosa et al. [12] focus on peroneal tendon dislocation and give us a clinically oriented proposal for classification and choice of treatment.