Abstract:[Objective] To compare the clinical efficiency of Gong's four-step reduction and plaster-splint external fixation versus con- ventional manual reduction and plaster- splint external fixation in the treatment of ankle fractures. [Methods] A retrospective study was conducted on 90 patients who received manual reduction and external fixation with plaster splint for ankle fractures in our hospital from June 2020 to June 2022. According to preoperative doctor- patient communication, 45 patients received Gong's four- step reduction and plaster external fixation (the Gong's group), wile the other 45 cases received conventional manual reduction plaster external fixation (the conventional group). The clinical and imaging data were compared between the two groups. [Results] The VAS scores significantly de- creased (P＜0.05), while the AOFAS score and ankle ROM significantly increased in both groups over time after treatment (P＜0.05). The Gong's group proved significantly superior to the conventional group in terms of VAS score [(1.9±0.3) vs (2.4 ±0.3), P＜0.001], AOFAS score [(90.3±3.9) vs (86.4±4.4), P＜0.001] and ankle ROM [(51.4±4.9)° vs (49.0±5.2)°, P=0.027) 6 months after treatment. Regarding imaging, there was no significant difference in articular surface reduction quality between the two groups (P＞0.05), but the Gong's group was signifi- cantly better than the conventional group in terms of tibiocrural angle (TCA) [(76.5±4.8)° vs (73.8±4.5)°, P=0.007], medial clear space (MCS) [(3.5±0.3)mm vs (3.9±0.4)mm, P＜0.001] and tibiofibular clear space (TFCS) [(6.0±1.5)mm vs (6.6±1.2)mm, P=0.039] after treatment. [Conclusion] Both techniques of manual reduction do effectively treat ankle fractures. By comparison, the Gong's four-step reduction and plaster external fixation is superior to conventional manual reduction plaster external fixation.