[Objective] To explore the clinical effect of anterior to posterior screws in the treatment of posterior malleolus fractures. [Methods] We retrospectively analyzed the data of 53 patients with PMF who were treated in our hospital from June 2015 to December 2020. There were 24 men and 29 women. The fractures were classified based on Naoki’s classification system: posterolateral oblique (32 patients), medial extension (14 patients), and small shell (7 patients). An incision was made along the posterior edge of the fibula. After the PMF fragments were reduced, 2 or 3 cannulated compression screws were inserted from anterior to posterior for fracture fixation. The surgical procedure, postoperative condition of the fracture reduction, perioperative complications and postoperative function recovery were analyzed. [Results] A total of 53 patients completed the follow-up . The imaging evaluation of postoperative fracture reduction was based on the Burwell-Charnley score. Anatomical reduction was achieved in 47 patients, and acceptable reduction was achieved in 6 patients. The average Score(AOFAS) was 90.85±6.54 points. [Conclusion] Fixation with compression screws inserted from the anterior to posterior is a reliable fixation approach with less trauma, which is conductive to early functional exercises. Internal fixation causes less irritation to the posterior structures of the ankle joint, such as the flexor longus and Achilles tendon. The method reduces postoperative pain and is minimally invasive and effective.