Pediatric ankle fractures are common and have unique fracture characteristics because of the presence of distal tibial and fibular physes. When displaced (>3 mm widening of the physis or >2 mm intra-articular gap/step-off), these fractures are typically treated with anatomical reduction and internal fixation. Computed tomography is recommended for preoperative evaluation and surgical planning for intra-articular fractures. These fractures in younger children with substantial growth remaining should be followed closely to monitor for any growth disturbance. Pearls and pitfalls related to the treatment of these fractures would emphasize the physeal-respecting approach to their management.