[Abstract] Objective To investigate the clinical effect of ankle arthroscopic assisted closed reduction and internal fixation in the treatment of pilon fractures. Methods 24 patients with Pilon fracture (AO/OTA classification type B and C1 and C2) were randomly divided into ankle arthroscopic group and incision reduction group to implement reduction and internal fixation. The postoperative follow-up time was 6-12 months. The clinical effects of the two groups were compared from several aspects, such as operation time, intraoperative perspective time, incision length, hospitalization days, fracture healing time, complications and American Ankle Surgery Association (AOFAS) score. Results The ankle arthroscopic group was superior to the incision reduction group in the aspects of cutting length, hospitalization days, fracture healing time, complication, Aofas. In the intraoperative perspective time, the incision reduction group was significantly better than that of the ankle arthroscopy group, but there was no statistical difference in the operation time between the two groups. Conclusion Ankle arthroscopy assisted closed reduction internal fixation is the firstchoice in the treatment of pilon fracture, for its small trauma, less bleeding, fast recovery, short hospitalization time, less complications.