Objective To explore the method, surgical points and efficacy of a single front and outer bypass therapy that combines fibula fractures. Methods Retrospective analysis of 22 cases of Pilon fractures with fibula fractures from April 2015 to January 2019 using a single front-external single incision therapy combined fibula fractures. Results 22 cases were all returned, with surgery time of 85-160 minutes (average 120 minutes), blood loss 200-500 ml (average 310 ml), and 3-7 times (average 5 times) during surgery. 1 case of filiastoic skin injury, no vascular damage. Follow-up time 12 months to 33 months, an average of 18.3 months. The fractures are all healed, with a healing time of 12-20 weeks. The fracture reset was evaluated using Burwell-Charnley imaging evaluation criteria: 8 cases of anatomical reset and 14 cases of reassignment. 12 months after surgery, the American Orthopaedic Ankle Association (AOFAS) ankle-rear foot scoring system to evaluate ankle function: 7 cases, good 8 cases, general 5 cases, 2 cases. The excellent rate was 68.2 per cent. Conclusion A single front and outer incision to treat complex Pilon fractures, as long as strictly follow the incision indications, gentle operation in surgery, reasonable use of indirect reset technology, fractures can be satisfactorily reset, soft tissue coverage, can reduce the occurrence of skin necrosis and infection, fracture healing is good, is a good way to operate.