AIM:To report ankle fracture configurations and bone quality following arthroscopic-assisted reduction and internal-fixation(ARIF)or open reduction and internalfixation(ORIF).METHODS:The patients of ARIF(n=16)or ORIF(n=29)to treat unstable ankle fracture between 2006 and 2014 were reviewed retrospectively.Baseline data,including age,sex,type of injury,immediate postoperative fracture configuration(assessed on X-rays and graded by widest gap and largest step-off of any intraarticular site),bone quality[assessed with bone mineral density(BMD)testing]and arthritic changes on X-rays following surgical treatments were recorded for each group.RESULTS:Immediate-postoperative fracture configurations did not differ significantly between the ARIF and ORIF groups.There were anatomic alignments as 8(50%)and 8(27.6%)patients in ARIF and ORIF groups(P=0.539)respectively.There were acceptable alignments as 12(75%)and 17(58.6%)patients in ARIF and ORIF groups(P=0.341)respectively.The arthritic changes in follow-up period as at least 16 wk following the surgeries were shown as 6(75%)and 10(83.3%)patients in ARIF and ORIF groups(P=0.300)respectively.Significantly more BMD tests were performed in patients aged>60 years(P<0.001),ARIF patients(P=0.021),and female patients(P=0.029).There was no significant difference in BMD test t scores between the two groups.CONCLUSION:Ankle fracture configurations following surgeries are similar between ARIF and ORIF groups,suggesting that ARIF is not superior to ORIF in treatment of unstable ankle fractures.