Objective Application of minimally invasive fixation in Maisonneuve fracture surgery. Approach precisely select 15 cases of Maisonneuve fracture over the past three years, including 2 cases of sports injury, 4 cases of car accident, 9 cases of sprain and fall. Ages of the patients in these 15 cases range from 39 to 72. Adopting minimally invasive fixation, all the surgeries are performed with fixation of medial malleolus fracture (or repair of triangular ligament), fixation of anterior and posterior avulsion fracture of lower tibiofibular or suture to strengthen ligaments, fixation of posterior ankle, as well as the repair of lower tibiofibular syndesmosis. Result With suture removal time 13-14days, all stitches were removed in the first stage of healing and no infection occurred. The follow-up time of 15 patients ranges from 6 to 18 months, using the scoring criteria of American Orthopaedic Foot and Ankle Society (AOFAS). Overall efficacy: excellent, 90-100 points; good, 75-89 points; fair, 50-74 points; poor, < 50 points. Thus, 10 cases meet the criterion of excellent, while 5 cases good. Conclusion After understanding the injury mechanism of Maisonneuve fracture, precise repair of the medial malleolus, posterior malleolus, lower tibiofibular joint and other structures is performed by minimally invasive fixation, with less surgical trauma and reliable fixation, and better postoperative efficacy is achieved.