Computed tomography is useful for preoperative planning and postreduction assessment for intra-articular pediatric ankle fractures. Nondisplaced pediatric ankle fractures can be effectively managed with cast immobilization and close radiographic follow-up evaluation. Physeal ankle injuries in younger children with considerable growth remaining should be followed closely for at least one year after injury as growth arrest may result in substantial angular deformity. Open reduction and internal fixation should be strongly considered when an articular step-off of <2 mm cannot be maintained by closed means for Salter-Harris type-III and IV and transitional ankle fractures.