Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of modified combined approaches for Klam- mer type Ⅲ posterior Pilon fracture. [Methods] A total of 21 patients received open reduction and internal fixation through posterolateral combined with modified posteromedial approaches for Klammer type III posterior Pilon fracture from January 2018 to April 2021. The pos- terolateral incision was made in the middle line between the posterior edge of the distal fibula and the Achilles tendon, then separate be- tween the peroneus and the flexor hallux longus tendons to expose the posterior column of the distal tibia; while to expose the distal fibula if the full-thickness fasciocutaneous flap was retracted anterolaterally. In addition, the modified posteromedial approach was made along the posteromedial edge of the distal tibia, and separate between the posterior tibialis and the bone with pulling all the tendon, blood vessels and nerve bundles posteriorly to expose the medial column of the distal tibia. [Results] All patients had operation performed successfully, and followed up for (15.2±1.5) months on an average. One patient developed superficial wound infection after operation and healed smoothly af- ter dressing change. At the last follow-up the VAS score for pain was of (1.9±0.2), while the AOFAS ankle hind foot score was of (86.0± 1.4). Radiographically, 18 patients obtained anatomical reduction and 3 patients had articular surface displacement of 1mm to 2mm postop- eratively, all the patients got bony healing of the fracture without loosening or breaking of the implants by the time of the latest follow up. [Conclusion] The posterolateral combined with modified posteromedial approaches for open reduction and internal fixation of Klammer type Ⅲ posterior Pilon fracture in prone position with the advantages of full exposure, high reduction rate and few complications, are safe and effective surgical approaches.