Abstract:[Objective] To compare the clinical efficacy of open reduction and internal fixation for tibiofibular fractures with or without fixation of the fibular fracture. [Methods] A retrospective analysis was conducted on 54 patients who received surgical treatment for tibiofib- ular fractures in the Department of Traumatic Orthopedic, Ruikang Hospital, Guangxi University of Traditional Chinese Medicine from January 2018 to January 2020. Based on preoperative communication between doctors and patients, 29 patients had tibial fracture fixed, combined with fibular fracture fixed simultaneously (the fixed group), while other 25 patients had the tibial fracture fixed only, without fixation of the fibular fracture (the non-fixed group). The perioperative, follow-up, and imaging data were compared between two groups. [Results] All the patients in both cohorts had the surgical procedures successfully completed without any related complications during the operation. Although the fixed group had significantly longer surgical time [(112.4±13.3) min vs (81.0 ±11.2) min, P＜0.001] and total incision length [(7.0± 1.3) cm vs (4.9±1.2) cm, P＜0.001] than the non-fixed group, the former had significantly fewer intraoperative fluoroscopy times [(3.0±0.9) times vs (5.1±1.4) times, P＜0.001] and resumed postoperative walking significantly earlier than the latter [(8.4±1.4) days vs (24.9±3.0) days, P＜0.001]. All patients in both cohorts were followed up for a period of 12~18 months, and the fixed cohort resumed full weight-bearing activity significantly earlier than the unfixed group [(22.1±1.3) weeks vs (23.4±1.0) weeks, P＜0.001]. Compared with those 3 months after surgery, both groups showed significant improvements in VAS, HSS, AOFAS scores, and ankle dorsal flexion-plantar flexion range of motion (ROM) (P＜0.05) at the last follow-up. The fixed cohort proved significantly superior to the non-fixed counterpart in terms of VAS [(0.2±0.3) vs (1.3± 0.8), P＜0.001], HSS [(88.8 ± 0.7) vs (87.3 ± 2.1), P＜0.001], AOFAS [(91.3 ± 6.6) vs (79.7 ± 14.0), P＜0.001], knee extension-flexion ROM [(134.9±5.5)° vs (126.2±6.1)°, P＜0.001], and ankle ROM [(58.1±8.4)° vs (44.2±10.4)°, P＜0.001] at the latest interview. Regarding imaging,the fixed group also was significantly better than the non-fixed group in excellent rate of fracture reduction and the imaging fracture healing time (P＜0.05). [Conclusion] In open reduction and internal fixation of tibiofibular double fractures, fixing the fibular fracture yields better clinical outcomes, and is a feasible method.