Ankle fractures are one of the most common fractures requiring operative treatment. They occur most commonly in postmenopausal women and younger men and recent studies suggest that the incidence of ankle fractures is increasing. In this registry study, we analyze inpatient data of operatively treated ankle fractures during a period of 33 years from our comprehensive nationwide register data. The data on operatively treated ankle fracture patients between January 1, 1987 and December 31, 2019 was collected from the Finnish National Hospital Discharge Register and analyzed. 118,929 ankle fractures were treated operatively. These included lateral malleolar fractures (33%), bior trimalleolar fractures (51%), medial malleolar fractures (7%), and other fractures (9%). Mean age was 53 (SD 17) years for women and 43 (16) for men. The average annual incidence rate was 69 per 100,000 person-years. Over the past 3 decades incidence has leveled off for women and has started to decline for men. However, the incidence is increasing in the elderly women group (over 70 years of age). In the over 50 age group, comorbidities have increased over the years, being more common in men than in women. The incidence of ankle fractures was higher during the winter months (November-March). The number of operatively treated ankle fractures has leveled off during the last 33 years. However, nowadays we operate on more difficult fractures in elderly patients with comorbidities.