Abstract:[Objective] To investigate the clinical efficiency of digital planning (DP) open reduction and internal fixation (ORIF) of Pi-lon fractures. [Methods] A total of 102 patients who had Pilon fractures being treated surgically from May 2019 to May 2022 were randomlydivided into two groups. Of them, 51 patients received ORIF based on DP to simulate fracture reduction before the real surgery, while other51 patients underwent the conventional ORIF. The perioperative period, follow-up and imaging data of the two groups were compared. [Re-sults] The DP group proved significantly superior to the conventional group in terms of operation time [(93.6±18.0) min vs (107.6±20.3) min,P＜0.001], total incision length [(14.6±2.9) cm vs (17.2±3.4) cm, P＜0.001], intraoperative blood loss [(72.6±19.4) ml vs (87.2±20.5) ml, P＜0.001], intraoperative fluoroscopy times [(4.8±1.4) times vs (6.9±1.7) times, P＜0.001], incision healing scale [A/B, (50/1) vs (44/7), P=0.027],and hospital stay [(18.3±5.9) days vs (21.7±4.3) days, P＜0.001]. However, there was no significant difference in the time to resume fullweight-bearing activities between the two groups (P＞0.05). The ROM, VAS and AOFAS scores in both groups were significantly improvedover time postoperatively (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05).As for imaging, there was no statistically significant difference in the quality of fracture reduction between the two groups (P＞0.05). [Con-clusion] Preoperative digital planning for open reduction and internal fixation of Pilon fractures is helpful to shorten the operative time andfracture healing time, and promote the recovery of ankle joint function.