[Objective] To compare clinical outcomes of open reduction and internal fixation (ORIF) of fractures with or without del- toid repair for ankle fractures accompanied with deltoid ligament tear. [Methods] A retrospective study was conducted on 82 patients who received surgical treatment for ankle fractures accompanied with the syndesmosis injury and deltoid ligament tear from January 2018 to June 2019. Based on the results of preoperative doctor-patient communication, the patients were divided into two groups. Among them, 41 patients underwent ORIF for fractures combined with deltoid ligment repaired, while the remaining 41 patients had ORIF only without del- toid ligament repaired. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 82 patients had operation completed successfully without serious complications. The repaired group was significantly greater than the unrepaired group in term of operation time, total incision length, and intraoperative blood loss (P＜0.05) . All patients were followed up for 12-18 months, with an average of (14.39±2.17) months. The patients in the repair group recovered to full weight bearing significantly earlier than those in the unrepaired group (P＜0.05) . The VAS score decreased significantly (P＜0.05) , while the AOFAS score and ankle dorsiflexion-plantar flexion ROM and ankle and foot varus-valgus ROM increased significantly over time postoperatively in both groups (P＜0.05) . However, the repaired group proved significantly superior to the unrepaired group at the corresponding time point in the VAS and AOFAS scores (P＜ 0.05) , despite of the fact that the repaired group had significantly less ankle foot varus-valgus ROM than the unrepaired group (P＜0.05) . Regarding to radiographic assessment, there was no statistically significant difference in MCS, TFCS and TFO between the two groups at the corresponding time points (P＞0.05) . The repaired group got fracture healing significantly earlier than the unrepaired group (P＜0.05) . [Conclusion] The deltoid ligament repairing is beneficial to improve the clinical outcomes of surgical treatment for ankle fracture accompanied with deltoid ligament tear.