While many unstable displaced fractures of the ankle are best treated by open reduction and internal fixation, situations arise in which a formal open operative procedure is contraindicated. Ulcerations about the ankle, severe peripheral atherosclerotic vascular disease, marked fracture blebs, and concomitant severe thoracic, abdominal, or neurological injury all contraindicate open reduction. In such patients a closed reduction supplemented by Steinmann-pin fixation proximally and distally has proved to be effective.