A retrospective review of 80 consecutive patients treated at a county hospital for ankle fracture/dislocations (initial displacement > 10 mm) was undertaken. Seventy-seven patients fulfilled the requirements for documentation and follow-up. Eighteen patients were transferred from another facility and 59 patients were seen at our institution primarily. The transfer and no-transfer groups were similar in age, sex, follow-up, type of ankle fracture, and number of concomitant injuries. The no-transfer group had a slightly higher Injury Severity Score and incidence of active medical problems. Patients were transferred to this public hospital for financial considerations in 89% of the cases. The patients seen in transfer had a higher rate of overall complications (67% vs. 26%; p = 0.0001), including deep infections (11% vs. 1.7%) and major reduction failures (17% vs. 7%). Higher rates of complications were also found in patients with delayed time to operation, psychiatric or substance abuse problems, and those with skin abrasions or blisters. Analysis of variance indicated that transfer status was the strongest predictor of complications. Hospital stays were also longer in the transferred group.