Abstract: [Objective] To compare the clinical results of nice knot fixation versus screw fixation for distal tibiofibular syndesmosis injury. [Methods] A retrospective study was conducted on 40 patients who received surgical treatment for distal tibiofibular syndesmosis injury from May 2013 to June 2018. Of them, 21 patients had distal tibiofibular syndesmosis injury fixed by nice knot using polyester suture (Ethicon, USA), while the remaining 19 patients fixed by srews (Weigao, Shandong，China). The operation time, complications, healing time, full weight loading time and AOFAS score were compared between the two groups. [Results] All patients were followed up, the follow-up time of group A was 20.48 ± 4.88 months, and that of group B was 22.95 ± 5.12 months. One patient in group A had superficial wound infection, and one patients in group B had superficial wound infection. The average operation time (reduction and fixation of the lower tibiofibular syndesmosis) was 13.62 ±2.44 minutes in group A and 16.53 ±2.34 minutes in group B. There was significant difference between the two groups（P<0.05）. The average time of fracture healing was 13.05 ± 3.14 weeks in group A and 14.11 ± 2.94 weeks in group B, there was not significantly different between the two groups (P>0.05). The average time of complete weight-bearing in group A was 10.05±1.94 weeks, and in group B it was 11.37 ± 2.00 weeks. There was significant difference between the two groups（P<0.05）. At the last follow-up, the average AOFAS score in group A was 89.86 ±+13.23, while that in group B was 80.37±15.16. There was a significant difference between the two groups（P<0.05）. [Conclusion] Nice knot for the treatment of distal tibiofibular syndesmosis injury is stable and reliable. It is a kind of elastic fixation, and retains the physiologic micromotion function at the syndesmosis. It is conducive to early functional exercise and recovery of ankle joint function, and reduces complications. It is an effective method for the treatment of distal tibiofibular syndesmosis injury.