Ninety-nine patients with unstable ankle fractures were randomized to receive either fibular nail fixation (n=48) or open reduction internal fixation (n=51). The primary outcome of interest was the development of osteoarthritis. Secondary outcomes included re-operation rates and patient-reported outcome measures (PROMs) such as the Olerud and Molander Ankle Score, the Manchester-Oxford Foot Questionnaire, and the Euroqol-5D. Outcomes were assessed at a minimum of 10 years post-intervention. Overall, the results of the study revealed no statistically significant differences in the development of osteoarthritis (p=0.851) or re-operation rates (p=0.518). PROMs also showed no significant differences between the two groups. These findings suggest that both treatment methods result in satisfactory long-term outcomes with no significant differences in late complications or quality of life measures at 10 years.