Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of reduction and internal fixation with plate and intermedullary nail using a distractor in lateral position with knee flexion for tibiofibular fractures. [Methods] From June 2020 to June 2021, 46 patients received the abovesaid surgical treatment for tibiofibular fractures. The patient was placed in the lateral decubitus posi- tion with knee flexion in 90 degrees and the affected limb parallel to the healthy limb. Schanze pins were inserted in the tibial plateau and calcaneus respectively, and then the shelf-developed retractor was attached with the pins applying axial distraction force to reduce the frac- tures and maintain the reduction. Under this condition, the fibular fractures were fixed with a plate by MIPPO technique through small inci- sions, subsequently, the tibial fractures were fastened with an interlocking intermedullary nail inserted through the inferior patellar ap- proach. [Results] All the patients had operations conducted successfully, without neurovascular injury or other serious complications, while with operation time of (118.5±2.0) min, intraoperative blood loss of (120.8±8.1) ml, and X-ray exposure time of (20.1±3.2) s. The patients were followed up for (12.3±2.2) months on a mean, and got clinical healing of the fractures in (24.1±1.8) weeks postoperatively, and were marked American Society for Foot and Ankle Surgery's ankle-hindfoot score of (92.8±2.6) at the latest follow-up. [Conclusion] The reduc- tion and internal fixation with plate and intermedullary nail using self-developed distractor in lateral kneeling position for tibiofibular frac- tures do facilitate surgical operation, intraoperative fluoroscopy to achieve rapid facture reduction, with advantages of reducing the loss of in- traoperative reduction and shortening the operation time.