Abstract:[Objective] To investigate the clinical outcomes of interlocking intramedullary nail combined with tibiofibular screw for fixation of distal fibular fracture complicated with inferior syndesmosis injury. [Methods] A retrospective study was conducted on 29 patients who had distal fibular fracture fixed with interlocking intramedullary nail, and tibiofibular syndesmosis fixed by tricortical screw in our hospital from January 2019 to February 2022. The clinical and imaging data were evaluated. [Results] All patients were operated successfully with operation time of (51.8±10.3) min, the intraoperative blood loss of (68.3±14.3) ml, the total incision length of (42.5±3.6) mm, and followed up for (13.7±2.4) months. The VAS score, AOFAS score and ankle ROM were significantly improved over time (P＜0.05). In terms of imaging, compared with those preoperatively, the inferior tibiofibular overlap (TFO) [(2.1±0.7) mm, (8.1±1.3) mm, (8.0±1.1) mm, P＜0.001] and talocrural angle (TCA) [(73.9±4.2), (83.1±3.0), (82.4±2.9), P＜0.001] increased significantly 6 months after surgery and at the latest follow-up, while the tibiofibular clear space (TFCS) decreased significantly [(8.3±1.3) mm, (4.3±0.5) mm, (4.4±0.5) mm, P＜0.001]. [Conclusion] The interlocking intramedullary nail combined with tibiofibular screw does effectively treat distal fibular fracture complicated with inferior tibiofibular syndesmosis injury, with advantages of small incision, less bleeding, anti-rotation and reliable fixation of the syndesmosis.