[Objective] To investigate the clinical outcomes of minimally invasive plate osteosynthesis (MIPO) with a large distractor for type II and III Pilon fractures. [Methods] A retrospective study was done on 48 patients who underwent surgical treatment for type II and III Pilon fractures in our hospital from March 2017 to April 2020. According to the consequence of preoperative doctor-patient commu- nication, 28 patients were treated with MIPO using a large distractor (the distractor group) , while the remaining 20 patients were treated with conventional open reduction and internal fixation (ORIF) (the conventional group). The perioperative, follow- up and imaging docu- ments were compared between the two groups. [Results] All patients in both groups had operation completed successfully. The distractor group proved significantly superior to the conventional group in terms of operative time, intraoperative blood loss, fluoroscopy times and in- cision length (P＜0.05) , but there was no significant difference in incision healing grade and hospital stay between the two groups (P＞0.05) . At the latest follow up lasted for more than 12 months, the VAS scores significantly decreased (P＜0.05) , while the AOFAS score and ROM significantly increased in both groups compared with those preoperatively (P＜0.05) . However, there were no statistical significances in the above items between the two groups at any corresponding time point (P＞0.05) . Radiographically, there was no significant difference in frac- ture reduction quality between the two groups according to Burwell-Charnley's criteria (P＞0.05) . In addition, there was no significant dif- ference in fracture healing time on images between the two groups (P＞0.05) . [Conclusion] The MIPO with a large distractor for Pilon frac- ture has the advantages of short operation time, small incision, less intraoperative fluoroscopy and less blood loss.