This episode uses a large Finnish registry study of 84,000 ankle fractures as a springboard to explore early and late complications after ORIF, highlighting a 7.2% early complication rate largely driven by infection and a long-term implant removal rate of 17%. The hosts draw on practice experience to discuss risk factors such as diabetes, wound management strategies, and the role of fracture boots. They review evidence comparing operative and non-operative care in older, low-demand patients and debate when medial malleolar fixation is necessary. The conversation turns to implant irritation, functional gains after hardware removal, and the need for future trials on implant design and early weightbearing. Overall, the episode emphasizes evidence gaps, modifiable perioperative factors, and opportunities for large, detailed trials to refine ankle fracture care.