Objective To introduce the technique and preliminary clinical outcomes of Pilon fracture with Weber C fibular fracture treated with a modified anterolateral approach. Methods From January 2018 to October 2019, 16 cases of Pilon fractures with Weber C fibular fractures were treated with this modified anterolateral approach. The incision runs between the front edge of tibia and fibula, extending straightly to 1 cm below the ankle joint, then turns at a 110-degree angle, proceeding medially to the midline. The fibula fracture was exposed between the peroneus and the extensor digitorum longus, and then fixed with a locking plate or one-third tubular plate. The distal tibial fracture was exposed medially and laterally to the tibialis anterior tendon, and then fixed with a medial and an anterolateral anatomical plate. Results 16 patients were followed up for a mean period of 13.44 months, no infection and flap necrosis were observed except in 2 cases. There were no failure of internal fixation and no reduction loss during the follow-up. All fractures achieved union with an average period of 13.75 weeks. The mean AOFAS score was 82.94 points at the latest follow up, with 4 patients excellent, 10 good and 2 fair. Conclusion The modified anterolateral approach for Pilon fracture with Weber C fibular fracture provides excellent exposure, fewer complications and satisfactory prognosis.