71 patients with an ankle fracture were randomized to undergo internal fixation using either an intramedullary nail or a plate. Patients were evaluated for radiographic union at 1 year postoperatively, and were also assessed for functional outcome using the Kitaoka score and Olerud-Molander score. Results demonstrated similar union rates between intramedullary nails (100%) and plates (94%). Functional outcomes were significantly better with the intramedullary nail, and fewer complications were also recorded in the group. Seven patients initially allocated to the intramedullary nail had to be converted to plate fixation due to technical reasons.