Ankle fractures in geriatric patients are common and challenging due to comorbidities and the risk of functional decline. Management must ensure fracture stability while promoting early mobilization to prevent complications and maintain independence. Open reduction and internal fixation remains the standard for unstable fractures; however, alternative techniques such as fibular intramedullary nail or tibiotalocalcaneal nail are suitable for fragile patients, as they reduce wound complications and permit early weight-bearing. Conservative treatment is appropriate for stable fractures or patients with low functional demands. Therapeutic decisions should be individualized to minimize morbidity and preserve mobility.