Seventy-six consecutive displaced open ankle fractures were treated by immediate internal fixation between 1983 and 1986 at Los Angeles County University of Southern California Medical Center. Sixty-two patients were available for clinical and radiological examination at an average of 16.4 months post-fixation. Seventy-two percent of the patients had a satisfactory result. Poor results (20%) were most commonly due to non-anatomic reductions, articular surface damage, or deep infection. Deep infection occurred in 5% of the patients while 8% required late ankle arthrodesis. We believe immediate internal fixation is the treatment of choice for displaced open ankle fractures, but this form of treatment does have a significant rate of complications.