Sixty-four patients with unstable ankle fractures were randomized to receive locking plate fixation (n=26) or intramedullary (IM) nail fixation (n=38). Outcomes of interest included peri-operative total surgical time, incision size, peri-operative total screening time, and the incidence of infection at 6 weeks follow-up. Additional outcomes of interest included the Olerud and Molander functional score, the Grimby score, incidence of swelling around the malleoli, plantar flexion, dorsiflexion, inversion , and eversion, measured at 3, 6, and 12 months follow-up with the addition of 6 weeks follow-up for the swelling around the malleoli, plantar flexion, dorsiflexion, inversion and eversion outcomes. The results revealed that scar size was statistically significantly lower of the IM nail group (p<0.001), whilst screening time was statistically significantly lower in the plate fixation group (p<0.001). All other outcomes at all timepoints were not statistically significantly different between the plate and IM group (p>0.05).