160 patients with type B ankle fractures were randomized to either operative or nonoperative treatment. The purpose of this study was to determine whether surgical treatment offers superior outcomes compared to nonsurgical management of type B ankle fractures with minimal talar shift. Findings indicated a mean difference between groups in the AAOS Foot and Ankle Outcomes Questionnaire (FAOQ) which favoured the operative group compared to the nonoperative group, and no significant difference in SF-12 General Health Survey results between groups over 12 months post-intervention. Incidence of adverse events was significantly higher following operative management versus nonoperative management.