Abstract Purpose To compare and study the priority reduction order of tibia and fibula in the operation of type B and C Pilon fractures combined with fibular fractures, and evaluate the effectiveness. Methods 150 cases in Tongling municipal hospital from January 2016 to January 2020 were analyzed retrospectively Type B and C Pilon fractures with fibular fractures, Combined with the posterolateral approach, 76 cases were divided into tibia group and 74 cases were divided into fibula group according to the reduction order, The operation time, fracture healing time, incidence of postoperative complications and ankle hindfoot (AOFAS) score 1 year after operation were analyzed. Results for type B and C3 fractures, the operation time of fibula group was better than that of tibia group (P < 0.05). There was no significant difference between C1 and C2 groups (P > 0.05); There was no significant difference in fracture healing time between the two groups (t = 4.783, t = 5.663; P＞0.05）； The number of delayed wound healing in tibial group was higher than that in fibula group (t = 2.119, P < 0.05), and the number of internal fixation loosening was lower than that in fibula group (t = 7.302, P = 0.031), but there was no significant difference in the incidence of complications between the two groups (x2 = 7.334, P > 0.05), One year after operation, the excellent and good rate of ankle posterior AOFAS function score was 88.1% in tibial group and 90.5% in fibular group. There was no significant difference between the two groups (x2 = 4.563, P < 0.05). Conclusion combined with posterolateral approach, priority reduction of fibula can effectively shorten the operation time of type B and C3 Pilon fractures combined with fibular fracture, and reduce the poor postoperative wound healing.