Ankle fractures are traditionally treated with open reduction and internal fixation (ORIF). Arthroscopy has emerged as a valuable adjunctive technique, to assist the surgeon with the treatment of some of these fractures. Posterior hindfoot arthroscopy has proven useful to assist the surgeon in the treatment of specific talar and calcaneal fractures by providing visualization of fracture reduction and screw positioning and to reduce the risk of soft tissue complications. This approach may allow for precise intervention with minimal surgical exposure, potentially leading to better preservation of the surrounding soft tissues and a lower risk of wound complications. Arthroscopy has also been proposed to detect associated intra-articular injuries. Although evidence suggests that arthroscopy can improve the detection of intra-articular injuries in ankle fractures, its routine application is debated, with no conclusive proof of superior patient outcomes compared with conventional open treatment without diagnostic arthroscopy.