[Objective] This study was aimed to explore direct visualization reduction from a anterior and posterior approach for acute syndesmosis injuries among the patients with Weber C ankle fractures.[Methods] A retrospective study was performed, and eighty-five patients with acute syndesmosis injury combined with Weber C ankle fracture were included. According to whether the anterior tibiofibular clear space was incised and exposed or not, all cases were divided into two groups, namely the direct visualization reduction group and the control group. There were 42 patients in the direct visualization reduction group and 43 patients in the control reduction group. Clinical outcomes between pre- and postoperation and two groups were evaluated with the American Orthopaedic Foot & Ankle Society(AOFAS) ankle-hindfoot scale, Visual Analogue Scale(VAS), the rate of malreduction and the rate of arthritis of ankle joint. [Results] There was significant difference between groups with regard to post-operative malreduction rate of syndesmosis evaluated at 2 days, 3 months and last follow-up(P﹤0.05). At last follow-up, there was statistical significance difference between groups with respect to the mean AOFAS score and VAS score (all P﹤0.05). Comparsion of arthritis rate of ankle joint was performed at last follow-up, showing no statistical significance between two groups(P﹥0.05). [Conclusion] Comparied with the indirect visualization reduction, the direct visualization reduction from a anterior and posterior approach applied to treatment of acute syndesmosis injuries in Weber C ankle fractures can increase AOFAS score of ankle joint effectively by reducing malreduction rate of syndesmosis markedly, and then make patients return to society as soon as possible. It is crucial for a successful operation to expose and handle tibiofibular clear space with direct visualization, reconstruct fibular notch anatomically, and reduct and repair tibiofibular syndesmosis primarily and precisely。