The primary objective of this study is to determine the failure rate and difference in clinical outcomes between operative and non operative treatment of patients with Weber B lateral malleolus ankle fractures with medial clear space widening on gravity stress views. All patients presenting will be treated non operatively, and compared to an observational group comprised of patients with Weber B lateral malleolus ankle fractures without medial clear space widening, for which the standard of care is non operative management.

Patients who decline non operative management and elect to undergo operative open reduction internal fixation with plates and screws will comprise an operative observational cohort.

All patients will be followed for a total of 12 months from the time of injury. Clinical outcomes will be based on radiographic monitoring for ankle mortise congruency, as well as standardized SF-36 and AOFAS questionnaire scores.

Inclusion Criteria:

• 18-65 years old
• able to provide informed consent

Exclusion Criteria:

• pregnancy
• prisoners
• psychiatric conditions that prevent ability to provide informed consent or present barriers to follow up
• insulin dependent diabetics
• patients with prior musculoskeletal issues affecting the same extremity
• Patients cannot simultaneously be enrolled in any other studies.