During 2012-2013, 20 patients with isolated fractures of the medial malleolus were treated conservatively by immobilisation in a cast.The results were assessed by examination, radiography and American Orthopaedic Foot and Ankle Society ankle-hindfoot score and Foot and Ankle Disability Index score, of the 20 fractures 17 healed without further treatment. Isolated fractures of the medial malleolus can obtain high rates of union and good outcome. Operation should be reserved for bi- or trimalleolar fractures, fractures involving the plafond or for patients who developed painful non union.