The authors have reviewed 194 malleolar fractures. 164 cases were treated conservatively. Less of half of them led to satisfactory results. 44 cases were operated on either primitively or after failure of conservative treatment. 29 satisfactory results were noted on 33 cases reviewed after a one year (or more) follow-up. Both foci were systematically approached, including the cases where a ruptured fragment existed in place of the malleolar fracture. Important third posterior fragments were fixed by a postero-lateral approach in prone position. Usually the lateral malleoli were fixed by screwing or plating or wiring. Medial malleoli were fixed by screwing or wiring. In some cases, collapse of the tibial roof had to be treated by grafting. The authors emphasize the importance of a fair repair of such lesions which should be recognized by tomographs. Indications are detailed. In any case, treatment should be applied in emergency for avoiding early blisters.