Abstract In many patients who undergo open reduction–internal fixation of ankle fractures, there is a failure to achieve good clinical outcomes despite radiographic evidence of anatomic reduction. One possible reason for this is the high incidence of concomitant intra‐articular pathology associated with ankle fractures that may go unrecognized using traditional open approaches. Arthroscopy in the setting of acute operative management of ankle fractures provides a means to completely assess intra‐articular pathology, as well as provide direct therapeutic intervention in many instances. Arthroscopic management techniques include debridement of loose intra‐articular fragments, assisted fracture reduction, microfracture of chondral injuries, and assessment of syndesmotic stability. The indications for arthroscopy in the setting of ankle fractures have not been fully defined; however, it is our practice to perform an arthroscopic assessment of all ankle fractures requiring surgical intervention. We present a sample of our experience using this technique that shows the severity of intra‐articular pathology that is often found and occurs even in association with fracture patterns with seemingly innocuous radiographic appearances.