Abstract Objective: To explore the clinical effect of Pilon fractures after the treatment of internal fixation with the posterolateral bone plate. Methods: A total of 36 patients with post-Pilon fractures admitted from February 2017 to May 2019 were selected. According to different fixation treatment methods, they were divided into observation group (18 cases treated with posterolateral bone plate internal fixation) and control group (18 cases treated with hollow screw fixation from front to back), and 12-20 follow-ups Month, observe the fracture rehabilitation, complications and clinical efficacy of the two groups of patients. Results: There was no significant difference in intraoperative blood loss, operation time, postoperative drainage, and hospitalization time between the two groups (P>0.05). The fracture healing time of the observation group was shorter than that of the control group, and the difference was statistically significant (P<0.05). All patients were followed up, the results were 12-20 months, and the average follow-up time was (16.72±3.68) months. Compared with the VAS score and ODI score of the two groups, there was no significant difference before the operation. The results of the last follow-up after operation showed that the VAS and ODI scores of the two groups of patients were improved, and the VAS and ODI scores of the observation group were significantly better than those of the control group (P<0.05). The AOFAS score of the observation group was significantly better than that of the control group (P<0.05), and the excellent and good rate of AOFAS in the observation group was 94.44%, which was significantly higher than the control group's 77.78% (P<0.05).The incidence of complications in the observation group was 5.55%, the incidence of complications in the control group was 22.22%, and the incidence in the control group was higher than that in the observation group, the difference was statistically significant (P<0.05). The excellent and good rate of reduction in the observation group was 94.44%, and that in the control group was 77.78%, the difference was statistically significant (P<0.05). Conclusion: The posterolateral approach bone plate internal fixation has a good clinical effect on Pilon fractures. The internal fixation effect is good, the complication rate is low, and the reduction rate is high. It is worthy of clinical promotion.