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Unstable ankle fractures in patients with complicated diabetes are an orthopedic challenge. Internal fixation, with augmentation, and prolonged immobilization and non–weight-bearing are important for improved patient outcomes. Despite the risks associated with surgical intervention, nonoperative treatment has been associated with significantly increased complications compared with operative treatment in diabetic patients with unstable ankle fractures.Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.