Objective To design a guide and fixation device for distal tibiofibular syndesmosis and verify its application value and effiectiveness. Methods A guide and fixation device for distal tibiofibular syndesmosis was designed and manufactured. 30 patients with distal tibiofibular syndesmosis injury were included from January 2017 to December 2018. Closed reduction and fixation with screws using the guide and fixation device for distal tibiofibular syndesmosis for all patients with distal tibiofibular syndesmosis injury . Observe wound healing; To evaluate whether the internal fixation was loose or broken; The ankle function was evaluated according to the AOFAS scores; Measure the range of dorsiflexion and plantar flexion motion of ankle. Results All patients were followed up for 13 to 26 months, with an average of (16.07 ± 3.24) months. No loosening or rupture of the internal fixation occurred. One patient developed a surgical incision infection and healed after 1 week of dressing change. One year after surgery, the ankle joint activity has approached the healthy side. According to the AOFAS score, the excellent rate of ankle function of the patient reached 100%. Conclusion Closed reduction and fixation with screws using the guide and fixation device for distal tibiofibular syndesmosis，the efficacy is reliable, and the function of the ankle is restored maximumly.