Ankle injuries are frequently encountered in several clinical settings and can range from mild ligamentous ankle sprains to devastating traumatic ankle fracture/dislocations. Most ankle sprains and fractures are secondary to rotational or twisting forces. The ankle joint is stabilized by bony constraints and several ligamentous complexes and damage to either of these can lead to instability, pain, and long-term challenges such as end-stage arthritis. Ankle sprains involve damage to the ligaments of the ankle joint and most commonly involve the laterally based ligaments. High ankle sprains are a subset of ankle sprains that involve injury to the syndesmosis—ligamentous complex between the tibia and fibula—and these injuries are often subtle, frequently missed, and take longer to heal. Most ankle sprains can be treated with conservative treatment which involves a short period of rest, ice, and elevation followed by physical therapy to maintain strength and proprioception. Surgery is reserved for severe and chronic cases with marked ligamentous injury and instability that does not respond to conservative management. Ankle fractures represent the other spectrum of ankle injuries. A thorough evaluation of these injuries is critical as ankle fractures can often present as open injuries with damage to nerves or vessels. While there is a subset of ankle fractures that are stable injuries due to preserve ligamentous anatomy, although most are unstable which require surgical fixation. Anatomic restoration of the articular surface is vital when treating ankle fractures surgically as even a small incongruity can lead to large imbalances in joint distribution forces leading to early and debilitating end-stage arthritis.