[Objective] To compare the effect of fibula preservation and fibula osteotomy in the treatment of supramalleolar osteotomy for adolescent ankle varus deformity. [Methods] A retrospective analysis was performed on 29 patients (29 feet) who underwent supramalleolar osteotomy for ankle varus deformity from January 2010 to December 2019. Among them, the fibula was preserved in 18 cases , and the fibula osteotomy was performed in 11 cases . The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the patients of both groups were successfully operated and the statistics of group A is superior to group B in terms of operation time and the length of the group, with statistical significance (P<0.05). In terms of incision healing, there was 1 grade B case in each group. The mean duration of follow-up of 49.7 + / - 19.4 months for two groups. The time of walking on the ground and the time of full weight-bearing in group A were significantly earlier than those in group B (P<0.05). Compared with preoperative data, at the last follow-up, the AOFAS ankle and hind foot scores of the two groups were significantly increased (P<0.05), and the VAS scores were significantly decreased (P<0.05). There were no significant differences in ankle dorsiflexion-plantar flexion ROM before and after the surgery, as well as in between the two groups. At the last follow-up, the osteotomy of all patients achieved bony union without internal fixation loosening. Compared with the data before operation, the distal tibial articular surface angle (TAS), tibial lateral articular surface angle (TLS), and tibial ankle angle (TC) angle of the two groups were significantly improved after operation (P<0.05). There was no significant change in talus tilt angle (TT) (P>0.05) Compared with the postoperative data, the TT angle of the two groups was significantly improved at the last follow-up (P<0.05), while the TAS angle was slightly decreased. Compared between the two groups, the TC angle of group B was better than that of group A after operation and at the last follow-up (P<0.05). [Conclusions] Both groups can achieve the purpose of distal tibial varus deformity. The data of group A was better in operation time, incision length, walking time, and full weight-bearing time, while the data of group B was better in terms of the convenience of correcting the TC angle.