87 elderly (>70 years of age) patients with an unstable ankle fracture were randomized to treatment through either closed reduction and intramedullary nail fixation, or open reduction and internal fixation using a plate and screws. Patients were assessed for the incidence of complications, length of stay, postoperative mobility status, and functional outcome on the Olerud-Molander score at 1 year postoperatively. Results demonstrated a significantly lower incidence of complications and shorter length of hospital stay in the nail group compared to the ORIF group. Postoperative mobility status and functional outcome did not significantly differ between groups.