The third common fracture in the elderly population is ankle fracture after the hip and the wrist fractures. As the life expectancy rises and due to higher rate of osteoporosis; the number of fragility fractures are increasing. In the elderly population, co-morbid diseases such as diabetes mellitus and osteoporosis alters the course of treatment of ankle fractures. In order to reach the best outcomes; every patient should be planned individually. There is a delayed fracture healing among the patients with diabetes due to both vascular insufficiency and peripheral neuropathy. Prior to surgery, vascular status of every single patient should be evaluated and in case of doubt vascular surgery consultation should be taken. The diagnosis of the neuropathy before the surgical intervention; good glycemic control, long immobilization period after the surgery and weight bearing protocol should be planned. Infection is a serious problem among those patients and should not be underestimated. Unstable ankle fractures can be best managed with surgical fixation. In this population, complication rates after the treatment of ankle fractures is high, including wound problems, union issues and Charcot joint.