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continued access to meaningful surgical orthopaedic trauma care in the United States. To examine the impact of insurance status on access to orthopaedic care and incidence of surgical site complications in patients with closed unstable ankle fractures. Retrospective chart review. Certified Level-1 urban trauma center and county facility. Four hundred eighty-nine patients with closed unstable ankle fractures undergoing open reduction and internal fixation between 2014 and 2016. Open reduction and internal fixation of unstable ankle frac