The longterm results of surgical and conservative treatment in two almost identical groups of patients with fractures of the ankle have been analyzed. The results were better after conservative treatment; delayed operation and repeated manipulations were found to be the main reason for the poorer postoperative results, especially in elderly osteoporotic patients. The damage consequent to repeated manipulations, the difficulties resulting from delaying operation, and the advantages of early open reduction are discussed. It may be that under certain conditions of unavoidable delay, a mild residual displacement should be accepted rather than repeated manipulation and delayed open reduction. It is concluded that, when indicated, operations should be performed as early as possible after injury, probably giving the best end results as evidenced by the preliminary findings of a prospective study currently under way.