Bimalleolar ankle fracture is a fracture that occurs in both the lateral and medial malleoli at the distal end of the tibia and fibula bones that articulate with talus bone to form the ankle joint or tibiotalar joint. This joint is in the mortise and tenon joint classification. It is supported by ligaments to stabilize the talus under the tibia and the tibia with the fibula. This type of fracture often affects these ligaments. These crucial ligaments include the syndesmotic ligaments that stabilize the fibula within the incisura in the tibial bone, and another critical ligament is the deltoid complex ligament, which is a broad ligament with a fan-like structure that originates from the medial malleolar to insert in the talus bone; it also subdivides into two ligaments. The most common ligament injury or cut is the deltoid ligament (medial ligamentous) during the medial malleolar fracture, causing joint instability. Bimalleolar ankle fracture is caused by twisting with multiple force mechanisms, or supination injury. The most common mechanism that cuts this ligament is foot eversion or external rotation force. Conversely, in the inversion mechanism, the primary ligament injured is the anterior talofibular ligament, and hyper-dorsiflexion trauma might cause syndesmotic ligament tears or sprains. According to the Lauge-Hansen and the Weber classifications, this fracture is unstable, and it classifies as Supination-External Rotation Injuries III, V (Weber Type B) that requires operative intervention. This fracture can lead to disabling long term sequelae following treatment, making this type of fracture have a poor prognosis.[1][2][3][4][5][6][7][8][9]