Ankle injuries are among the most common orthopedic problems encountered in the Emergency Room (ER). The assessment of ankle injuries requires a careful history, physical examination and, if fracture is suspected, ankle radiography. If the decision is made to obtain a radiograph, the physician needs a careful and systematic approach for interpreting the film in order to avoid missing fractures. As well, there are patterns of injuries that the physician should be aware of to determine whether the fracture can be managed with simple immobilization or whether it requires emergent orthopedic assessment.