Abstract Aim To assess compliance of the management of ankle fractures with ORIF at Aberdeen Royal Infirmary and Woodend Hospital against the management of ankle fractures guidelines in the BOA standards for trauma. Method A retrospective analysis of patients who underwent ORIF of ankle fractures from 12/06/2022 to 06/06/2023 was conducted. Pilon fractures and open fractures were excluded. Operations notes, admissions, discharge and clinic letters, and imaging were used. Results 201 patients met the inclusion criteria. 155 patients had complex fractures (posterior malleolus involvement, Maisonneuve, or syndesmotic injury); 46 had non-complex fractures. Only 47.74% of the complex fractures underwent CT imaging. Post-operation, only 14.43% and 12.45% of patients were full weight-bearing and partially weight-bearing, respectively. 97.01% of all patients had a follow-up clinic within 6 weeks post-operation. However, following the first clinic follow-up, only 24.88% and 25.87% were full weight-bearing and partially weight-bearing, respectively. The remaining patients were classified as non-weight-bearing. Conclusions Most of the patients were managed according to the guidelines. However, greater use of CT imaging for complex fractures can be done for defining fracture configurations. Additionally, more patients need to be allowed weight-bearing immediately post-operation and after their first follow-up clinic, as promoted by the BOA. Results were presented at the 21/11/23 mortality and morbidity meeting, and this issue was acknowledged by the orthopaedic surgeons. The post-operation note template will be revised, and a poster including the BOA guidelines on weight-bearing and imaging will be introduced in the department. A re-audit will be done in 2024 to assess any changes.