Fifty-six patients with lateral malleolar (rotational ankle) fractures were randomized to receive 2-octyl cyanoacrylate (n=27) or n-butyl (90% n-butyl/10% 2-octyl) cyanoacrylate (n=28) for skin closure after standardized plate fixation; fifty-five completed follow-up. The primary outcome was cosmetic appearance by HWES at three and six months. Secondary outcomes included patient satisfaction with cosmesis by VAS (0–100) and 5-point Likert scales at three and six months, and ankle function by OMAS at six months. Overall, the results of the study revealed no statistically significant differences between groups for HWES, VAS, Likert satisfaction, or OMAS at six months. In short, 2-octyl and n-butyl cyanoacrylate were clinically comparable options for ankle incision closure.