Abstract: Objective：To study the effect and safety of the transfibula approach and the posterior lateral approach in the treatment of the fracture of the ankle and the posterior lateral approach.Methods：69 patients with ankle fracture were selected from March 2017 to February 2018 in our hospital.According to the criteria of LaugeHansen classification，all of them reached the grade Ⅲ～Ⅳ of posterior circumflex type.According to（RCT）undefineds principle of randomized controlled trial，35 patients in group A were treated with plate screw fixation through fibula approach，34 patients in group B were treated with plate screw fixation through posterolateral approach，and 35 patients in group A were treated with plate screw fixation via posterolateral approach.The clinical operative indexes（operative time，intraoperative bleeding，bone healing time，hospitalization days）and related complications were compared between the two groups.The ankle joint healing was evaluated after 12 months followup.Results：The operative time of group A was（113.78±11.79）min，the intraoperative blood loss was（251.97±36.87）ml，the number of days of hospitalization was（18.57±2.17）d and while the data in group B was （109.87±12.31）min，（266.04±37.19）ml，（17.96±2.01）d，respectively，there was not statistically significant（P>0.05）.The bonehealing time of group B was（51.57±6.18）d，which was significantly shorter than that of group A[（59.68±7.54）d）]，the difference was significant（P<0.05）.The functional scores of AOFAS（40.59±6.29，64.08±6.68，79.84±7.14，92.87±5.58）and the rate of recovery（93.75%）were significantly higher in group B than in group A（32.15±5.17，53.77±5.19，64.87±6.68，83.47±5.09，74.19%）.The difference was significant（P<0.05）.In group A，4 cases of postoperative incision infection，4 cases of bone union still had an ankle joint pain，and only 1 incision infection in group B.There was a significant 〖LM〗difference between the two groups（P<0.05）.Conclusion“” Transperoneal approach or posterolateral approach has a good effect on the treatment of Ⅲ and Ⅳ degree ankle fractures，and the posterolateral approach has more advantages，which can shorten the cycle of bone healing and guarantee the stability of ankle joint，and the posterior lateral approach has the advantages of shortening the cycle of bone healing and ensuring the stability of ankle joint.To promote the recovery of ankle function.

Key words: postspin type, ankle fracture, fibula approach, posterior lateral approach