Objective: To compare the clinical effects of ligament reconstruction and tension screw fixation on lower tibiofibular instability. Methods: 64 cases of ankle pronation fracture with lower tibiofibular instability treated in our hospital from March 2019 to June 2020 were selected. 32 cases of ligament reconstruction (reconstruction group) and 32 cases of tension nail fixation (fixation group) were used. The surgical indexes, postoperative functional scores and imaging indexes of the two groups were compared. Results: the operation time of the two groups was the same, the ankle function score was the same at 6 and 12 months after operation, and the imaging indexes were the same between the two groups before and after operation, with no significant difference (P > 0.05); The weight-bearing time in the reconstruction group was shorter than that in the fixation group, and the ankle function score in the reconstruction group was higher than that in the fixation group 3 months after operation (P < 0.05). Conclusion: ligament reconstruction and tension screw fixation of lower tibiofibular instability can achieve satisfactory clinical results, but the former has the advantages of early weight-bearing and faster functional recovery.