objective ：To evaluate the effect of the direct view via the fracture gap during the reduction and fixation of the posterior malleolar displaced fracture in the trimalleolar fracture. Methods: Forty-two patients with posterior malleolar displaced fractures in the trimalleolar fracture treated by hand-foot surgery were selected from 2014.1 to 2017.12. The reduction and fixation of the posterior malleolar fracture were performed under direct vision via the fracture gap. The Short Musculoskeletal Function Assessment (SMFA) was used to evaluate the postoperative recovery. Results: All patients achieved bone healing. There were no cases requiring revision surgery or infection after operation. The ankle joint flexion and flexion function was good. The patient's SMFA dysfunction index averaged 8.0 ± 1.7 points, and the SMFA trouble index averaged 2.2 ± 1.3 points. All patients underwent normal daily activities for an average of 3 months after surgery. Conclusion：For the treatment of posterior malleolar displaced fractures in the trimalleolar fracture, it may be a better choice to use the reduction and fixation method via fracture gap under direct vision.