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Complete avulsion of the superficial deltoid complex off the medial malleolus can occur during high-energy ankle fractures in young patients. Partial deltoid ligament injuries can also occur with avulsion fractures off the tip of the medial malleolus in low-energy ankle fractures in the elderly. Infolding and retraction of the avulsed deltoid complex can cause persistent widening of the medial clear space and lead to ankle fracture malreduction, postoperative medial gutter pain, and medial ankle instability. It is important for physicians to recognize and repair superficial deltoid ligament injuries in the setting of ankle fractures in order to restore ankle collateral ligament anatomy and help improve clinical outcomes. The deep deltoid ligament is generally difficult to repair in the acute setting and reconstructed later on if chronic ankle instability and valgus deformity develop in the future.Level of Evidence: Level V—Expert Opinion.