Background: To examine outcomes of open reduction internal fixation (ORIF) of patients with medial malleolar fractures that were fixed using a wire-form fixation device. We hypothesize that patients who undergo operative intervention using the wire-form fixation device can expect union rates, clinical and functional outcomes comparable to those of other methods of fixation. Methods: A retrospective review was conducted of all patients with medial malleolar fractures who underwent ORIF of medial malleolar fractures from November 2006 to June 2011. Electronic medical records were reviewed for clinical and radiographic outcomes. Medial malleolar fractures were classified using the Herscovici classification system. Patients were contacted via telephone to complete the American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire and the Short Musculoskeletal Form Assessment. Results: A total of 21 patients underwent ORIF of medial malleolar fractures utilizing the wire-form fixation device and 19 met inclusion criteria for this study. There were 18 Herscovici type C (10 transverse, 8 oblique) fractures and 1 class D (vertical) fracture. Ten of the patients were female. Average age was 43+/-4 years (range, 20 to 80 y old). Average length of follow-up was 48+/-3 months (range, 20 to 71 mo). The average time to surgery was 12+/-1 days (range, 6 to 19 d). There were no intraoperative complications and all fractures went on to union. In 2 patients the wire-form fixation device caused pain due to irritation. One patient underwent surgery to remove the painful implant and 1 patient desired surgery for device removal during the study. There was 1 case of superficial cellulitis. Conclusions: The wire-form fixation device provides reliable fixation for ORIF of transverse, oblique, and vertical, medial malleolar fractures. Nonunion, reoperation rates, and other complication rates are similar to other medial malleolar fixation methods. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.