[Objective] To introduce the surgical technique and preliminary clinical results of a modified anterolateral approach for Pi- lon fracture accompanied with Weber C fibula fracture. [Methods] A total of 16 patients received open reduction and internal fixation through the modified anterolateral approach for Pilon fracture accompanied with Weber C-type fibula fracture from January 2018 to Octo- ber 2019. This approach was gone between the anterior edges of tibia and fibula, extending downward to about 1cm below the ankle joint, forming a 110° arc and to the medial of the ankle midline. The fibula fracture ends were exposed between the peroneus and the extensor digitorum longus, and then a locking plate or 1/3 tubular plate was placed for fixation of the fibula. Subsequently, the medial column, mid- dle column and lateral column of the distal tibia were exposed inside and outside of tibialis anterior tendon, and the medial and anterolater- al anatomical plates were placed for fixation of the tibia. [Results] All patients had operation performed successfully, and followed up for (13.44±3.43) months. No complications such as infection and flap necrosis occurred except 2 patients. During the follow-up, all patients had no complications, such as internal fixation loosening and loss of fracture reduction. Clinical fracture healing time was of (13.75±1.75) weeks on average. The AOFAS score at the latest follow-up was of (82.94±7.39) , with excellent outcomes in 4 cases, good in 10 cases and fair in 2 cases. [Conclusion] This improved anterolateral approach for Pilon fracture accompanied with Weber C fibula fracture has the ad- vantages of full exposure and fewer complications, and is beneficial to the recovery of ankle function.